Differentiating osteomyelitis from bone infarction in sickle cell disease

Abstract

This brief review discusses one possible approach to evaluating the sickle cell patient with bone pain. The major differential diagnoses include osteomyelitis and bone infarction. Based on previous studies, we provide an approach to assessing and treating patients with the possible diagnosis of osteomyelitis. An algorithm has been provided, which emphasizes the importance of the initial history and physical examination. Specific radiographic studies are recommended to aid in making the initial assessment and to determine whether the patient has an infarct or osteomyelitis. Differentiating osteomyelitis from infarction in sickle cell patients remains a challenge for the pediatrician. This algorithm can be used as a guide for physicians who evaluate such patients in the acute care setting.

Ten-Year Review of Hospital Admissions among Children with Sickle Cell Disease in Kuwait

“…and S. aureus , which are the most common bacteria responsible for osteomyelitis in SCD [23] . Increasingly, we are using MR imaging in such patients to identify those who show evidence of subperiosteal pus collection and bone marrow signal abnormalities suggestive of osteomyelitis [24,25] .…”

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease — can it differentiate bone infarcts from acute osteomyelitis?

“…The interaction of these processes causes erythrocyte membrane damage, hemolysis and microvascular occlusion [3]. Vaso-occlusive crises are responsible for splenic infarcts with early decrease in splenic function and subsequent immunosuppression, predisposing children to acute osteomyelitis [4,5]. Additionally, repeated bone vaso-occlusive crises lead to chronically poor vascularization and anatomical risk for bone infection.…”

“…Both diagnoses also result in similar laboratory abnormalities including leukocytosis and elevated inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) [4,6,7]. The gold standard for the diagnosis of osteomyelitis is a positive culture from a sampling of bone, synovial fluid or blood.…”

“…However, obtaining a bone culture is often not feasible in the pediatric population, and blood cultures are frequently negative in children with acute osteomyelitis [7,8]. Lack of microbiological data does not exclude the diagnosis of osteomyelitis [4,7]. Thus most experts suggest the integration of clinical symptoms, laboratory findings and imaging studies for the differentiation of acute bone infarct and acute osteomyelitis in children with SCD [4,6,7].…”

“…Thus most experts suggest the integration of clinical symptoms, laboratory findings and imaging studies for the differentiation of acute bone infarct and acute osteomyelitis in children with SCD [4,6,7]. It is important to realize that a bone infarct is 50 times more common than osteomyelitis in children with SCD [4,5].…”