A Patient with Pediatric Septic Arthritis of the Hip Complicated with Osteomyelitis Responds to Clindamycin

Tokai J Exp Clin Med. 2019 Dec 20;44(4):113-117.

Abstract

A 5-year-old girl was referred to our institution with complaints of right hip pain and fever (39.0°C); blood tests and magnetic resonance imaging (MRI) were performed. Blood biochemical results revealed a high inflammatory reaction. MRI results revealed inflammation in the hip joint. She was diagnosed with pediatric septic arthritis of the hip, which required arthrotomy and lavage drainage. Treatment with intravenous vancomycin was initiated on the assumption that the causative bacterial species was Staphylococcus aureus. However, Group A Streptococcus pyogenes (GAS) was subsequently isolated from an intraoperative sample, and the antimicrobial agent was switched to aminobenzylpenicillin (ABPC). Clindamycin (CLDM) was added to the treatment regimen 14 days after surgery as MRI indicated the development and spread of osteomyelitis. Three months post-surgery, MRI findings indicated that the osteomyelitis had resolved and antimicrobial therapy was discontinued. To prevent the spread of osteomyelitis, a combination of CLDM and ABPC should be considered at an early stage, particularly in pediatric patients with GAS-induced septic arthritis.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Arthritis, Infectious / diagnosis
  • Arthritis, Infectious / drug therapy*
  • Arthritis, Infectious / surgery
  • Child, Preschool
  • Clindamycin / administration & dosage
  • Clindamycin / therapeutic use*
  • Female
  • Gram-Positive Bacterial Infections / diagnosis
  • Gram-Positive Bacterial Infections / drug therapy*
  • Gram-Positive Bacterial Infections / surgery
  • Gram-Positive Cocci / drug effects
  • Gram-Positive Cocci / isolation & purification
  • Hip / diagnostic imaging
  • Hip / microbiology*
  • Hip / surgery
  • Humans
  • Magnetic Resonance Imaging
  • Osteomyelitis / diagnosis
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / surgery

Substances

  • Anti-Bacterial Agents
  • Clindamycin