Abstract
Acute bilateral symmetrical pyogenic osteomyelitis in children is rare. The purpose of this paper is to increase awareness of the existence and severity of this condition.
The clinical records and radiographs of eight children with acute bilateral symmetrical osteomyelitis seen between 1990 and 2003 were reviewed. All had typical clinical and laboratory features of acute osteomyelitis. The duration of symptoms ranged from 7 to 14 days. The age range was 5 to 12 years.
The sites involved were the proximal femora in two patients, the distal femora in two, the proximal tibiae in two, the calcanei in one and the clavicle in one. All patients had fluctuant abscesses and underwent incision and drainage. Staphylococcus aureus was cultured in all cases and treated with cloxacillin for 6 weeks.
Follow-up ranged from 18 months to 4 years. All except the patient with the clavicular lesion had poor outcomes. Patients with femoral neck involvement had avascular necrosis, pathological fractures and ankylosis. The children with distal femoral and upper tibial involvement developed chronic osteomyelitis, with sequestra, sinuses and knee joint ankylosis. The child with calcaneal involvement developed bilateral ankle, subtalar, calcaneocuboid and talonavicular fusion.
Bilateral symmetrical haematogenous osteomyelitis is a severe disease caused by a virulent organism. Symmetrical and simultaneous infection of the same bones is reported mainly in congenital syphilis and chronic recurrent multifocal osteomyelitis, which is associated with skin lesions. All children presenting with acute osteomyelitis should be thoroughly examined to exclude symmetrical and multifocal sites of involvement. A bone scan may be useful in the early detection of involved sites.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
