An infant not moving her leg

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 appearin...

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Bibliographic Details
Published in:The American journal of emergency medicine 2016-04, Vol.34 (4), p.756.e1-756.e2
Main Authors: Berkowitz, Tal, MD, Young, Deborah, MD
Format: Article
Language:English
Subjects:
Ankle
Ankle - pathology
Anti-Bacterial Agents - therapeutic use
Antibiotics
Babies
Bacterial infections
Blood
Case studies
Emergency
Emergency medical care
Female
Humans
Infant, Newborn
Infants
Infections
Laboratories
Laboratory tests
Leg - physiopathology
Leukemia
Magnetic Resonance Imaging
Movement
Osteomyelitis - diagnosis
Osteomyelitis - drug therapy
Radiography
Streptococcal Infections - diagnosis
Streptococcal Infections - drug therapy
Streptococcus agalactiae
Tibia - diagnostic imaging
Tibia - microbiology
Tibia - pathology
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Summary: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.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2015.07.073