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Case Reports
. 2024 Mar:116:109284.
doi: 10.1016/j.ijscr.2024.109284. Epub 2024 Jan 26.

Chronic humeral osteomyelitis in an adult with sickle-cell disease

Pablo Viñuales  1 , Paola Andrea Hortua  2 , Jordi Zafra  3 , Ramón Clos  4 , Jordi Villalba  5
Affiliations
Case Reports

Chronic humeral osteomyelitis in an adult with sickle-cell disease

Pablo Viñuales et al. Int J Surg Case Rep. 2024 Mar.

Abstract

Introduction and importance: The rising incidence of sickle-cell disease in European countries has led to an increase in associated complications. Osteomyelitis, a rare complication in non-traumatic adult cases, poses diagnostic challenges and presents treatment difficulties due to limited cases and studies.

Case presentation: A 23-year-old woman diagnosed with sickle-cell disease presented with a six-day fever and painful swelling in the left upper extremity persisting for a fortnight. She had no history of trauma but had experienced a previous episode of bacteremia due to Salmonella, four years prior. Magnetic resonance imaging revealed an intramedullary bone injury with cortical rupture extending into soft tissues, forming a collection that raised clinical suspicion of osteomyelitis, despite negative blood and aspirate cultures. Empiric antibiotic therapy was initiated, followed by surgical debridement of infected tissues. The resulting dead space was filled with antibiotic-coated calcium phosphate beads and tissue grafting. Anatomopathological studies confirmed findings consistent with chronic osteomyelitis. Stabilization of the arm was achieved with an orthopedic brace, and antibiotic administration continued for 6 weeks post-surgery. The injury consolidated 4 months after treatment, and nearly two years later she has not suffered a recurrence.

Clinical discussion: The scarcity of literature implies the absence of clinical guidelines for treating osteomyelitis in these patients. Empirical antibiotic therapy combined with surgery when there are abscesses that need debridement can be an effective approach.

Conclusion: Humeral osteomyelitis in sickle-cell disease patients can be effectively managed using a pharmaco-surgical strategy, but it should be tailored to the patient's needs.

Keywords: Case report; Empiric antibiotic therapy; Osteomyelitis; Sickle-cell disease; Surgical debridement.

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Conflict of interest statement

Declaration of competing interest The authors report no Conflict of Interest Statement.

Figures

Fig. 1
Fig. 1
Initial radiograph showing lysis in the middle third of the humeral diaphysis.
Fig. 2
Fig. 2
Humeral MRI. A) Sagittal slice revealing intraosseous and soft tissue collection. B) Axial slice with the measurement (mm) of soft tissue collection.
Fig. 3
Fig. 3
Identification of nerve structures during boarding. The condition of the soft tissues due to OM can be observed.
Fig. 4
Fig. 4
Exposure of the humeral bone following soft tissue debridement.
Fig. 5
Fig. 5
Humeral osteotomy after soft tissue debridement.
Fig. 6
Fig. 6
Filling of the bone defect with calcium phosphate beads impregnated with vancomycin and gentamycin for local antibiotic administration.
Fig. 7
Fig. 7
Definitive humerus immobilization with an orthopedic brace.
Fig. 8
Fig. 8
Postoperative radiograph. Calcium phosphate beads can be observed filling the bone defect and around soft tissues.
See this image and copyright information in PMC

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