• Montane B Silverman, Reece E Tuckerman, and Joseph Fisher.
• Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
• Mil Med. 2024 Jan 23; 189 (1-2): e457e459e457-e459.

AbstractPediatric osteomyelitis is a rare diagnosis associated with devastating consequences when treatment is delayed. We report a case of hematogenous osteomyelitis in a 5-week-old male presenting to the emergency department (ED) with a flaccid right upper extremity. In the ED, the patient was evaluated with comprehensive infectious and trauma workups. Initial CT imaging of the head and X-ray imaging of the extremity were unremarkable. C-reactive protein was elevated at 0.8; all other laboratory markers were within normal range. Over the course of the ED evaluation, the extremity weakness spontaneously resolved; however, the infant developed a fever of 100.5 F. Empiric broad spectrum antibiotics were initiated, and the infant was admitted to the pediatric service. At 48 hours following presentation, cultures resulted positive for Staphylococcus aureus and MRI imaging revealed osteomyelitis of the proximal right humeral metadiaphysis. Given the subtle presentation of early hematogenous osteomyelitis, emergency providers should maintain a high index of suspicion for infection as the underlying cause in infants presenting with a flaccid extremity.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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