Acute Hematogenous Osteomyelitis: It Might Not Be the Long Bones

A febrile child with a limp is a diagnostic challenge for clinicians because of the nonspecific clinical presentation and lack of localized inflammatory signs. Acute hematogenous osteomyelitis (AHOM) of tubular bones is a common cause of this presentation, but the findings of a retrospective chart review remind us that AHOM of the pelvis might have a similar presentation.

Of 220 children with AHOM diagnosed between 1986 and 2003 at a single institution in Switzerland, 19 (9%) had pelvic AHOM. Children with pelvic AHOM were older than children with non-pelvic AHOM (mean age, 8.0 vs. 6.2 years) and more likely to be male (72% vs. 57%). All patients limped or refused to walk. Among the children with pelvic AHOM, pain was localized to the thigh …