We report a neonate who presented with reduced movement and pain in the right arm which was misdiagnosed as Erbs palsy.The patient was born at term by ventouse weighing 3950 g following an uneventful pregnancy. No problems were noticed in the 1st week. He presented at the age of 2 weeks with reduced use of the right arm and distress when the arm was moved. His mother mentioned that the umbilical cord had been smelly. On examination, he was afebrile and his right arm was held in a waiter's tip position. An X-ray film of the right arm/shoulder revealed no abnormality. A diagnosis of Erbs palsy was made and he was referred for physiotherapy. Two weeks later he was still distressed when the arm was moved. A lymph node was palpable in the right axilla. A repeat X-ray film showed a lucent area in the humeral head ( Fig. 1). A radioisotope scan showed a 'hot spot' in the area.His C-reactive protein was elevated. Two blood cultures were negative. A diagnosis of osteomyelitis of the humerus was made. He was treated with intravenous penicillin and flucloxacillin for 2 weeks, followed by 6 weeks of oral co-amoxiclav. He made a full recovery. A follow-up X-ray film at the age of 4 months showed a normal humeral head.Neonatal osteomyelitis affecting the humerus can present as Erbs palsy [2]. Bone and joint sepsis is rare in neonates. Diagnosis is often difficult and delayed. The hip joint is the commonest followed by the shoulder or proximal humerus [1]. Neonatal osteomyelitis results from haematogenous spread and in one paper skin/ umbilical sepsis was a predisposing factor [1]. This is a possible source of infection in our case. In addition to Staphylococcus aureus, common causative organisms in neonates are group B Streptococcus species and Escherichia coli [1, 3]. References 1. Knudsen C, Hoffman E (1990) Neonatal osteomyelitis. J Bone Joint Surg Br 72B: 846-851 2. Sadleir L, Connolly M (1998) Acquired brachial plexus neuropathy: a rare presentation of late onset group B streptococcal osteomyelitis. Dev Med Child Neurol 40: 496-499 3. Vazquez M (2002) Osteomyelitis in children. Curr Opin Pediatr 14: 112-115 Fig. 1 X-ray film showing a lytic lesion with sclerotic margin and some periosteal reaction in the right humeral head Eur
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