Acute Osteomyelitis in the Left Wrist of a Neonate

Beatriz dos Santos Vieira*, Inês Mazeda Machado Correia, Joana Guimarães de Pinho, Catarina Aurora de Sousa Oliveira, Célia Albertina Nogueira Dias Madalena, Sílvia Maria Fernandes Pereira Saraiva

Abstract

Acute osteomyelitis occurs rarely in the neonatal period and may present as sepsis and/or swelling, erythema, and decreased mobility of the affected area, with or without fever and nonspecific constitutional symptoms. Further, osteomyelitis of the ulna is quite a rare form of pediatric osteomyelitis.

A 16-day-old female neonate was admitted for swelling, erythema, and decreased movement in the left wrist for the past 12 hours. The neonate’s general condition was good, and she had her left upper limb in pronation. The arm radiograph was normal. The initial laboratory analysis showed no leukocytosis, a negative C-reactive protein, and a normal erythrocyte sedimentation rate. After admission, empiric parenteral antibiotic therapy was started for presumed acute osteomyelitis. On day 1, she presented a single fever peak. Ultrasonography showed a deep soft tissue swelling and an apparent irregularity in the cortical contour of the ulnar head. Blood culture revealed the presence of Staphylococcus epidermidis. Magnetic resonance imaging of the wrist confirmed the suspicion of acute osteomyelitis of the ulna.

We present here a case of localized acute osteomyelitis at a very early age, which is a rare occurrence. A high index of suspicion is essential, as early diagnosis and prompt treatment reduce the risk of complications and important sequelae.