Subacute Hematogenous Ostemyelitis in Children

Ahn, Jae In; Kim, Byoung Suck; Won, Ye Yeon; Yun, Yio Hon

Abstract

Subacute hematogenous ostemyelitis is mostly likely due to an altered relationship between host and pathogen, associated with increase host resistance, decreased virulence of the causative organism and/or antibiotics modification. In a retrospective study of the hematogenous ostemyelitis in 156 cases, 19 cases of them were the subacute form of the ostemyelitis. Pain is the most consistent symptom and most of the constitutional symptoms were usually mild. However, the ESR was often elevated. From our data, the following results were obtained. 1. The most common skeletal involvement was the distal part of the tibia(8 out of 19 patients). 2. The causative organism was staphylococcus aureus by the bacterial culture of the specimens. 3. In the literature, acute hematogenous ostemyelitis rarely cross the physis in patients older than 18 months of its age. However, subacute ostemyelitis frequently does cross the physis(5 out of 19 patients). 4. Cross physeal lesions were healed without any permanant damage to the growth plate in our cases(5 out of 19 patients). 5. All patients except for one case were treated by curettage and antibiotics. 6. The mush higher incidence of the cross physeal lesions may be expected by MRI in identifying the lesion. 7. Seven out of 19 patients had radiographic findings similar to eosinophilic granjuloma, Ewing's sarcoma or osteosarcoma.