Multifocal Neonatal Osteomyelitis: Case Report

Neonatal osteomyelitis may present with very few clinical signs and symptoms, which makes prompt diagnosis challenging. Delayed treatment may result in serious long-term consequences. Moreover, all patients should be followed up for orthopaedic sequelae. Here we describe a case of neonatal osteomyelitis, at multiple sites. A preterm male presented with fever and mild abdominal distension on the 14th day of life. Investigations were done to rule out sepsis, meningitis and other common cause of fever. Despite starting empiric antibiotic coverage immediately, fever continued followed by respiratory distress, tachypnea and tachycardia. Three weeks later baby became pale and irritable with cell count of 34,450/cumm and was shifted to neonatal intensive care unit. In subsequent days, baby developed swelling in right thigh and knee region with paucity of movements, however ultrasonography failed to detect any pathology. Blood culture revealed methicillin resistant staphylococcus aureus, after which injection vancomycin was started, after which fever subsided and the baby’s general condition improved clinically. Ultrasonography suggested effusion in left shoulder and right knee, probably of infective etiology. Drainage and decompression with arthrotomy helped us evacuate sero-sanguinous turbid fluid and granulation tissue, which were sent for histopathological examination which diagnosed pyogenic synovitis. On 40th day of life the patient was discharged healthy.