Life-threatening pelvic osteomyelitis: pelvic destruction in an 8-year-old boy.

elv 1% (A P ic osteomyelitis is a rare occurrence, with reported rates of –11% of all cases of acute haematogenous osteomyelitis HO) occurring between the ages of 7 and 14 years. In a review of the medical records of 220 children with AHO, 19 children had pelvic osteomyelitis. A review of cases of AHO at our institution showed infection of the pelvis in 8% of 102 patients with AHO and a male : female ratio of 2.1 : 1. Pelvic osteomyelitis has been described in three entities — gluteal, lumbar and abdominal. Although these designations can be useful for determining the spread of infection, they have no prognostic value. Acute pelvic osteomyelitis is often not initially recognised. It can be difficult to detect due to its variable clinical signs and differential diagnoses. In one study, the time span between initial symptoms and the diagnosis ranged from 1 to 8 days. Difficulty diagnosing the condition may result in a delay of appropriate treatment. In our patient, plain radiographs (which are usually normal for the first 7–10 days) and magnetic resonance imaging (MRI) scans showed extensive bony and soft tissue destruction of the left hemipelvis, hip and thigh. Is it plausible that these changes occurred within 2 weeks, considering the patient’s history? As we were unable to find supporting reports in the literature, this matter was discussed within various hospital departments. Concerns were raised that the time frame was too short to cause this level of destruction. It was proposed that the mixed flora that were cultured could cause a high level of destruction within 14 days. Although plausible, there was no direct evidence to support this theory. Clinical record