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Multifocal Chronic Osteomyelitis to Multiresistent Serratia Marcescens and Bone Tuberculosis in Sickle Cell Disease

2018Other Open access
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dc.contributor.authorAraújo Carvalho, A
dc.contributor.authorGouveia, C
dc.contributor.authorMilheiro Silva, T
dc.contributor.authorRamos, S
dc.contributor.authorCandeias, F
dc.contributor.authorBrito, MJ
dc.date.accessioned2023-07-03T09:25:08Z
dc.date.available2023-07-03T09:25:08Z
dc.date.issued2018
dc.description.abstractIntroduction: Bone infection is an especially challenging diagnosis in patients with sickle cell disease and frequently difficult to treat, needing a combination of aggressive surgical treatment and prolonged agent specific antibiotic therapy, further complicated by multiresistant bacterias. Case Report: Nine-year old girl with sickle cell disease admitted in Luanda´s hospital with osteomyelitis and weight loss (7 kg). She started cefazolin and ciprofloxacin, followed by chloramphenicol and clindamycin, and after 22 days, she was admitted in our hospital with multifocal osteomyelitis. MRI showed osteomyelitis of humerus and radius bilaterally (with abscesses), bilateral arthritis of the elbows with left-handed effusion, synovitis/arthritis of the shoulders and spondylodiscitis of L4-S2. She was twice subjected to an orthopedic surgery for drainage of abscesses and joint decompression. The biopsies of bone and synovial liquid identified multiresistant Serratia marcescens, so she was medicated with meropenem and amikacin. Because there is no clinical improvement she received also hyperbaric oxygen therapy (20 sessions), with good evolution. After 32 days, she developed fever, leukopenia and neutropenia therefore vancomycin and amphotericin B were prescribed. Amphotericin B led to severe hypokalemia (1.7 mEq/L) and has been discontinued. He also presented tuberculin test and IGRA T-SPOT positives and considering spondylodiscitis, it was assumed bone tuberculosis and started isoniazid, rifampicin, pyrazinamide and ethambutol. After 1 month, she had toxic hepatitis requiring the interruption of tuberculostatic therapy and replacement of isoniazid with levofloxacin. She was discharged after 90 days and today still has some limitations: a slight one on right arm’s extension; on extension and supination of the left arm; and an abduction, anterior flexion and external rotation of her left shoulder. Discussion: Osteomyelitis complications can be severe causing significant impairment on bone development and quality of life. An early diagnosis and appropriate therapy can greatly improve long-term outcome. Besides antibiotic, adjuvant therapies such as bone decompression surgery or hyperbaric oxygen may be required on chronic and recurrent cases. As this case points out, when facing chronic osteomyelitis, not responding to usual therapy, clinicians should be aware of bone tuberculosis, particularly when treating patients from endemic areas.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationIN: 10th Excellence in Pediatrics Conference; 2018, 6 a 9 de Dezembro. Praga, República Checapt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4589
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherUnidade de Infecciologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE ;Unidade de Ortopedia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPEpt_PT
dc.subjectAnemia, Sickle Cellpt_PT
dc.subjectChronic recurrent multifocal osteomyelitispt_PT
dc.subjectTuberculosis, Osteoarticularpt_PT
dc.subjectSerratia marcescenspt_PT
dc.subjectHDE INF PEDpt_PT
dc.subjectHDE ORT PEDpt_PT
dc.titleMultifocal Chronic Osteomyelitis to Multiresistent Serratia Marcescens and Bone Tuberculosis in Sickle Cell Diseasept_PT
dc.typeother
dspace.entity.typePublication
rcaap.rightsopenAccesspt_PT
rcaap.typeotherpt_PT

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