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What’s Your Diagnosis? A 4-year-old with fever, right leg pain, and difficulty walking

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Case Presentation: a 4-year-old with fever, right leg pain, and difficulty walking

A 4-year-old boy presents to the ED with intermittent fever, right leg pain, and difficulty walking the last 3 days. His parents report that the child has a history of sickle cell disease and takes folic acid and penicillin for infection prophylaxis. The patient has never had surgery. On physical examination, there is point tenderness over the right thigh and an area of overlying edema, and the boy’s vital signs are within the normal limits for his age. You order a complete blood cell count, erythrocyte sedimentation rate, C-reactive protein, blood cultures, bone culture, and plain radiography.

What special bacterial pathogen must be considered in this case? How does this affect antibiotic treatment?

Case Conclusion

The 4-year-old boy with intermittent fever, right leg pain, and difficulty walking over the last 3 days was diagnosed with OM of the right femur. Since Salmonella is the most common cause of OM in patients with sickle cell disease, empiric treatment covering Salmonella was started. The bone culture grew out Salmonella. The patient was treated with vancomycin and ciprofloxacin parenterally for 5 days; he was then transitioned to oral therapy with a third-generation cephalosporin to complete 4 weeks of antibiotic therapy.

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