Systemic Infection of Pediatric Osteomyelitis - A Clinical Case in a Low-Income Country

Sep 28, 2026

Osteomyelitis is a severe bone infection that demands early diagnosis and targeted therapy, especially in pediatric patients whose symptoms may be complex and nonspecific. This case report documents a seven-year-old boy from Los Ríos, Santo Domingo, Dominican Republic, diagnosed with MRSA-associated osteomyelitis. He presented systemic illness with fever, vomiting, and abdominal pain, plus localized trauma, limb pain, and functional limitation. Examination showed hemodynamic instability and gastrointestinal involvement; labs indicated infection and malnutrition. Imaging confirmed left femur osteomyelitis and right forearm periosteal injury. Cultures from blood and soft tissue identified MRSA as the causative organism. Findings emphasize prompt imaging, microbial isolation, and multidisciplinary management, including intravenous antibiotics, monitoring, and prolonged medication.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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Abstract

Introduction

Pathophysiology and common causes

Acute versus chronic osteomyelitis

Treatment principles

Epidemiology and risk factors in children

Diagnostic approach

How to cite this article

Review began 09/29/2025 Review ended 11/23/2025 Published 12/02/2025 © Copyright 2025 Arulkumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98326 Open Access Case Report Systemic Infection of Pediatric Osteomyelitis: A Clinical Case in a Low-Income Country Pramodani Arulkumar 1, Rucha Bhat 2, Sibana Gonzalez 3, Aarush R. Patlola 4 , Sorivel Sosa 5 1. Biology, New York University, New York, USA 2. Public Health, Nova Southeastern University, Davie, USA 3. Biology, Saint Peter’s University, Jersey City, USA 4. Chemistry, King Philip Regional High School, Wrentham, USA 5. Research Department, Global Health Leaders, Arizona, USA Corresponding author: Pramodani Arulkumar, [pa2419@nyu.edu](pa2419@nyu.edu) Abstract Osteomyelitis is a severe bone infection that requires early diagnosis and targeted treatment, mainly in pediatric populations where clinical presentations can be complex and nonspecific. This case report presents a seven-year-old male from Los Ríos, Santo Domingo, Dominican Republic, diagnosed with methicillin-resistant Staphylococcus aureus (MRSA)-associated osteomyelitis. The child presented with systemic signs, including fever, vomiting, and abdominal pain, along with localized trauma, limb pain, and functional limitations. Clinical examination revealed hemodynamic instability and gastrointestinal involvement, while laboratory findings indicated infection and malnutrition. Imaging confirmed osteomyelitis in the left femur and periosteal injury in the right forearm. Blood and soft tissue cultures identified MRSA as the causative agent. This case highlights the importance of early imaging, microbial isolation, and a multidisciplinary approach in the management of pediatric osteomyelitis, such as intravenous antibiotics, monitoring, and long-term medications. It also underscores the need for increased awareness and diagnostic capabilities in developing countries to facilitate timely intervention and reduce long-term complications. Categories: Pediatrics, Infectious Disease, Orthopedics Keywords: acute osteomyelitis, clinical case, dominican republic, multidisciplinary care, pediatric, staphylococcus aureus Introduction Osteomyelitis is the inflammation and infection of bone, characterized by swelling and pain in the affected area. Recent research has advanced understanding of the pathophysiology and potential treatment strategies for osteomyelitis. Osteomyelitis is most commonly caused by pathogens. Hofstee, Muthukrishnan, Atkins et al. (2020) provide a comprehensive review that highlights how Staphylococcus aureus remains the primary causative pathogen in bone infections and describes its ability to penetrate and persist in cortical bone through submicron channels, pores less than one micrometer. They also revisit the critical role of osteocytes in recruiting immune cells to sites of infection and detail how leukocytes, including neutrophils, eosinophils, and basophils, contribute to the diagnosis of implant-associated osteomyelitis [1] . Osteomyelitis can be acute or chronic. Regarding this case study, acute osteomyelitis typically develops over a short period, usually within two weeks after an initial infection or injury, and can present subtly, with nonspecific symptoms like low-grade fever, irritability, or localized limb pain, making diagnosis challenging [2] . For treating osteomyelitis, previous research indicates that antibiotics and, if needed, surgery are the most effective. To remove the diseased bone, surgical debridement can be used, as antibiotics cannot penetrate the abscesses or infected fluids in the body as effectively. Only if surgical debridement cannot be done, then prolonged antibiotic treatment can be extended for months. Regarding

FAQs

What organism was identified as the cause of osteomyelitis in this case?

Blood and soft tissue cultures identified methicillin-resistant Staphylococcus aureus (MRSA) as the causative agent.

What clinical signs did the child present with?

The child showed systemic signs including fever, vomiting, and abdominal pain, along with localized trauma, limb pain, and functional limitations.

Why is early diagnosis emphasized in pediatric osteomyelitis?

Early diagnosis supports targeted microbial isolation and treatment planning, reducing long-term complications. MRI is highlighted as the gold standard for early assessment.

Sep 28, 2026

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