A 4-week-old female infant presented to the emergency department (ED) due to a 1-week history of not moving her left lower extremity as well as crying during diaper changes. She had been seen 6 days prior at an ED, had normal x-rays, and was discharged home. The infant was afebrile and well appearing and had been feeding well all week. Laboratory tests in our department, including a complete blood count with differential and inflammatory markers, were all normal. Repeat x-rays showed a subtle distal tibial lucency, initially overlooked. The infant was admitted to the hospital and received a magnetic resonance imaging,which demonstrated distal tibial osteomyelitis with an accompanying ankle effusion. Cultures from the bone grew group B Streptococcus, and the infant received 6 weeks of antibiotic therapy.