569 - A Rare Presentation of Acute Sternal Osteomyelitis in a Pediatric Patient with Sickle Cell Disease

Poster Number: 569
Publication Number: 569.321

Dina Khamash, The Children's Regional Hospital at Cooper, Camden, NJ, United States; WENDY DE LA RUA, The Children's Regional Hospital at Cooper, CHERRY HILL, NJ, United States; Anat R. Feingold, Cooper University Hospital, Camden, NJ, United States; Rafat Ahmed, Cooper Medical School of Rowan University, Camden, NJ, United States

Background:
Patients with sickle cell disease (SCD) are noted to have several complications resulting from vaso occlusion due to the dysmorphic shape of sickled red blood cells, for which they undergo close follow up and frequent imaging and laboratory studies. Given frequent episodes of bone infarction, osteomyelitis is one of the most common infections that they present with, usually involving the long bones and rarely affecting the flat bones.  In the general population, Staphylococcus aureus is the most common organism; however, in patients with SCD encapsulated organisms such as Salmonella are the most prominent causative agent. 

 

Objective:
This case report aims to describe the case of a 2 year old male with SCD who developed acute methicillin sensitive Staphylococcus aureus (MSSA) sternal osteomyelitis, beyond those previously identified

Design/Methods:
Single subject case report- developed with literature search of previous cases of osteomyelitis in pediatric patients with SCD
 

Results:
This is a 2 year old male with SCD and non-adherence with prophylactic antibiotics who presented with fever and diffuse abdominal pain. Patient was positive for Rhinovirus and Adenovirus and blood cultures grew MSSA. Fever curve improved after initiation of parenteral antibiotics; however, the patient developed sternal soft tissue swelling with mild discomfort only on deep palpation. Initial superficial ultrasound was consistent with cellulitis. Given worsening of swelling, chest MRI was obtained and revealed acute sternal osteomyelitis. PICC line was placed for a prolonged course of Cefazolin. The patient continues to follow closely with hematology, cardiothoracic surgery, and Infectious disease specialists.

 
Conclusion(s):
Osteomyelitis is an uncommon complication in children with SCD. Encapsulated organisms are usually the causative organisms and patients often have a history of prior vaso occlusive crises. These patients often present with fever and vaso occlusive crisis. This case describes the presentation of a rare complication of SCD given the site of infection, the causative organism, and absence of history of vaso occlusive crisis in this patient.