Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10‐year single‐center experience. Issue 5 (17th February 2020)

• Record Type: Journal Article
• Authors: Weisman, Julie K.; Nickel, Robert Sheppard; Darbari, Deepika S.; Hanisch, Benjamin R.; Diab, Yaser A.
• Is Part Of: Pediatric blood & cancer. Volume 67:Issue 5(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-02-17
• Subjects: osteomyelitis -- outcomes -- pediatrics -- sickle cell disease; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.28225
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract: Background: Patients with sickle cell disease (SCD) are at increased risk for osteomyelitis (OM). Diagnosis of OM in SCD is challenging as the clinical presentation is similar to a vasoocclusive crisis (VOC) with no diagnostic gold standard. We report characteristics and outcomes of OM in SCD patients treated at our center over 10‐year period. Design/Method: We conducted a retrospective analysis of patients with SCD who were treated for OM at our center over a 10‐year period (2006‐2016). Cases were identified utilizing radiology data mining software. Radiology reports and medical charts of potential OM cases were reviewed. Results: Twenty‐eight children with SCD were treated for OM at our institution. Patients treated for OM were largely similar to patients treated for a VOC. However, patients treated for OM had significantly higher C‐reactive protein (10 mg/dL vs 5.58 mg/dL, P = 0.03) and erythrocyte sedimentation rate (60 mm/h vs 47 mm/h, P = 0.02). Magnetic resonance imaging (MRI) findings were consistent with OM in 18 (64%) patients and indeterminate in the remaining. Based on clinical, laboratory, and radiological findings, the diagnosis of OM was considered confirmed in 3 patients, probable in 6 patients, and presumed in 19 patients. Nontyphoidal Salmonella was isolated from cultures in 9 (32%) patients, while no organism was identified in 19 (67%) patients. All patients were treated with antibiotics. Six patients (21%) required surgical interventions. Conclusions: OM continues to pose diagnostic challenges. Most patients are treated for OM without definitive confirmation. Nontyphoidal Salmonella was the only organism identified in our cohort.