Pelvic Osteomyelitis due toHaemophilus InfluenzaeType B in a Down Syndrome Child

Abstract

AAH Al-Omar, MJ Qureshi, AS Al-Jarallah, KF Al-Mobeireek. Pelvic Osteomyelitis due to Haemophilus Influenzae Type B in a Down Syndrome Child. 2002; 22(5-6): [341][342][343] Pelvic osteomyelitis in children is uncommon, and Staphylococcus aureus is the most commonly encountered organism. The diagnosis of pelvic osteomyelitis is usually delayed. With an early diagnosis and commencement of appropriate anti-microbial therapy, the outcome is usually favorable. We present a 14-month-old girl with Down syndrome and right iliac bone osteomyelitis secondary to Haemophilus influenzae type B. To our knowledge, the association of the elements of pelvic osteomyelitis, Down syndrome and H. influenzae has not been previously reported. Case ReportA 14-month-old Saudi girl, a known case of Down syndrome, and a product of full-term uneventful pregnancy, was fully vaccinated except for the H. influenzae conjugate vaccine. The conjugate vaccine is not a part of the national infant immunization program in the Kingdom of Saudi Arabia. The patient was not known to have any congenital heart disease. She presented to the Emergency department of King Khalid University Hospital with a history of fever associated with signs of upper respiratory tract infection (URTI) for a few days. She did not appear toxic. Blood culture was taken and she was discharged home. She was called back on the second day because the blood culture grew gram-negative coccobacilli. The coccobacilli reacted positive with H. influenzae B anti-sera. The organism as well grew in chocolate agar incubated at 37°C with CO 2 overnight and grew around the XV factor, but not around the X or V factors individually in the nutrient agar. The growth characteristics were consistent with H. influenzae B. It was sensitive to ampicillin, chloramphenicol, and secondand third-generation cephalosporins. The patient was diagnosed as "bacteremia" and treated with intravenous cefuroxime 100 mg/kg/day in three divided doses. After two days, the cefuroxime was changed to the oral route as her general condition improved and the fever subsided. Five days after she completed a 10-day course of antibiotics, she presented with fever and apparent discomfort on nappy changing-She appeared unwell with an axillary temperature of 38°C. She was hypotonic with no meningeal signs. There was tenderness on the right iliac bone with no swelling, redness or fluctuation. The rest of the physical examination was normal. WBC count was 11.2x10 9 /L with 34% polymorphs and 60% lymphocytes. The erythrocyte sedimentation rate (ESR) was 72 mm in the 1st hour. The patient was admitted and started on IV cefuroxime 100 mg/1kg/day after repeating the blood culture, which turned to be negative. Considering the anatomy of the pelvis and the previous antimicrobial therapy, culturing the pelvic bone was not tried. Pelvic x-ray was normal. Three-phase bone scan (Technitium Tc99 pyrophosphate) showed a focal area of increased uptake, with matched increase in gallium uptake in the right iliac bone consistent with osteomyelitis...