Acute haematogenous osteomyelitis of femur in a neonate with ‘bone within bone’ appearance: a case report.

ABSTRACT

Acute osteomyelitis in infants, which was known for high mortality and morbidity in the pre-antibiotic era can be managed conservatively by intravenous antibiotics and supportive therapy if the condition is detected and treatment started early in the course of the disease. Infantile osteomyelitis is separate entity from the one seen in older children in terms of vascular anatomy, pathogenesis, radiological changes and natural history. We present a neonate with acute haematogenous osteomyelitis of femur with preceding respiratory tract infection that was managed conservatively without surgical intervention despite severe radiographic changes. The child recovered without any residual deformity and final radiographs did not show any trace of the disease though early radiographs had exuberant involucrum formation and sequestration of entire diaphysis giving it a “bone within bone” appearance. Infants have excellent capacity of re-sorption of sequestrum and remodelling of involucrum such that no trace of disease is left in the adulthood.