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• W2076729941 abstract "To the Editors: Sternal osteomyelitis is defined as primary in the absence of any previous local condition. In this setting, the presence of any predisposing factors (sickle cell disease, immunodeficiency, etc.)1,2 is common, so its diagnosis in healthy children is infrequent. We present a case of primary sternal osteomyelitis in a previously healthy Caucasian 19-day-old boy with a 24-hour history of irritability. Examination showed a rectal temperature of 38.5°C (101.3°F) and a sternal 2 × 2 cm swelling fixed to the central third of the sternum (see Fig., Supplemental Digital Content 1, https://links.lww.com/INF/B477). Full blood count showed leucocytosis (37900 cells/µL) and neutrophilia (24256 cells/µL). C-reactive protein was 85 mg/L and procalcitonin was 0.22 ng/mL. The echography revealed a hypoecogenic collection in the sternal body causing osseous destruction without mediastinal extension (see Fig., Supplemental Digital Content 2, https://links.lww.com/INF/B478). CT-scan confirmed these findings. Surgical drainage was performed, growing in blood and surgical swab cultures methicillin-susceptible Staphylococcus aureus. The evolution was satisfactory and he left the ward after 13 days of intravenous antibiotherapy, which was continued orally for a total treatment of 5 weeks. Primary sternal osteomyelitis is an extremely rare condition, representing 0.3% of all the cases and 0.2% of the hematogenous cases in children.3 There are only 20 cases in pediatric population in the English and Spanish medical literature in the past 35 years. This figure is lower among otherwise healthy neonates (<4 weeks), with only 1 case reported in the Spanish literature4 and no cases in the English literature to our knowledge until this review. Table, Supplemental Digital Content 3, https://links.lww.com/INF/B479, summarizes the cases of primary sternal osteomyelitis in children published in the past 35 years in the Spanish and English medical literature. The sternal involvement is explained by the “fixation point theory”: the slow blood flux through the porous sternal matrix makes easy the settlement of bacterial microthombosis during childhood.3 S. aureus is the usual cause with 2 cases reported of community-acquired methicillin-resistant S. aureus. Other pathogens have been described in isolated cases, including Salmonella typhi in patients with sickle cell disease.2 Treatment of sternal osteomyelitis should be promptly started to avoid chest wall deformity and mediastinal extension. Empiric treatment includes gram-positive coverage and is tailored to the isolated pathogen. Classical approaches recommend the antibiotic to be maintained at least 2 weeks intravenously and up to 4 weeks more orally, although this tendency is changing to shorter duration and intravenous courses.5 Surgical debridement is recommended because of its importance in ascertaining the causative bacteria.3 Antonio José Conejo-Fernández, MB BS Francisco Jesús García Martín, MD Carolina Martínez de San Vicente Merino, MB BS Department of Pediatrics Hospital Xanit International Benalmádena, Málaga, Spain" @default.
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• W2076729941 date "2013-06-01" @default.
• W2076729941 modified "2023-09-25" @default.
• W2076729941 title "Primary Sternal Osteomyelitis and Septicemia in a Neonate" @default.
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• W2076729941 doi "https://doi.org/10.1097/inf.0b013e318287033b" @default.
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