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 Table of Contents  
LETTER TO THE EDITOR
Year : 2022  |  Volume : 37  |  Issue : 2  |  Page : 106-107

Iliac crest osteomyelitis: A rare complication of bone marrow aspiration in a 12-year-old boy with aplastic anemia


1 Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
2 Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India

Date of Submission12-May-2022
Date of Acceptance14-Sep-2022
Date of Web Publication19-Oct-2022

Correspondence Address:
Thirunavukkarasu Arun Babu
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri 522503, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jbjd.jbjd_7_22

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How to cite this article:
Ahmed Naseem J, Delhi Kumar C G, Arun Babu T. Iliac crest osteomyelitis: A rare complication of bone marrow aspiration in a 12-year-old boy with aplastic anemia. J Bone Joint Dis 2022;37:106-7

How to cite this URL:
Ahmed Naseem J, Delhi Kumar C G, Arun Babu T. Iliac crest osteomyelitis: A rare complication of bone marrow aspiration in a 12-year-old boy with aplastic anemia. J Bone Joint Dis [serial online] 2022 [cited 2022 Nov 29];37:106-7. Available from: http://www.jbjd.in/text.asp?2022/37/2/106/358802



Bone marrow aspiration (BMA) is the most common procedure performed for the diagnosis of various hematological disorders in children. BMA is a relatively safe procedure with very few complications such as pain, soft-tissue infections, and occasional bleeding at the aspiration site.[1] Here, we report a rare case of iliac crest osteomyelitis following the BMA.

A 12-year-old male child, a known case of aplastic anemia, presented with right lower abdominal pain for 4 weeks and fever for 2 weeks. Child was limping due to severe pain. All symptoms apparently started after a BMA done 4 weeks back. On examination, there was tenderness in the right iliac region and aspiration site. Initially, X-ray pelvis was done suspecting osteomyelitis, and ultrasonography abdomen to look for any intra-abdominal abscess, but both were normal. In view of severe pain and persistent fever spikes, contrast-enhanced computed tomography (CECT) pelvis was carried out, which showed osteomyelitis of the anterior part of the right iliac crest [Figure 1]A and a bone scan revealed increased tracer uptake at right anterior superior iliac spine (ASIS) [Figure 1]B. Blood culture grew staphylococcus aureus, which was sensitive to cloxacillin. The patient was managed with intravenous cloxacillin for 2 weeks followed by oral cloxacillin for 4 weeks and two packed red blood cells and platelets transfusions. Evaluation for secondary causes of aplastic anemia such as human immunodeficiency virus, parvovirus, Epstein–Barr virus, hepatitis B virus, hepatitis C virus, hepatitis A virus, and chromosomal breakage analysis were normal. Fever and pain resolved gradually, and the patient responded well to treatment. On follow-up, the child underwent allogeneic hematopoietic stem cell transplantation but developed primary graft failure and is currently on supportive treatment.
Figure 1: (A) CECT pelvis showing erosion on the anterior part of the right iliac crest with a solid type of periosteal reaction. (B) Bone scan showing increased tracer uptake at the right ASIS

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BMA is a very safe procedure with only 0.008% of serious adverse events.[1] Transient local pain and bleeding are the most common complications observed after BMA. Serious reported adverse events include massive hemorrhage, soft-tissue cellulitis, persistent pain at local site, breakage of bone marrow needle inside the bone, and bone fracture.[2] Recently, Tural-Kara et al.[3] reported the first case of iliopsoas abscess and sacroiliac osteomyelitis in an 18-month-old child. Here, we report another case of right iliac crest osteomyelitis following BMA. Methicillin-sensitive Staphylococcus aureus is the most common organism causing osteomyelitis after BMA.[4] Though BMA is a safe procedure, the treating physician should be aware of serious complications such as osteomyelitis. Hence, strict aseptic precaution is mandatory during BMA to prevent serious infectious complications.

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Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bain BJ Bone marrow biopsy morbidity and mortality. Br J Haematol 2003;121:949-51.  Back to cited text no. 1
    
2.
Gladden K, Spill GR Iliac fracture after a bone marrow biopsy. Pm R2011;3:1150-2.  Back to cited text no. 2
    
3.
Tural-Kara T, Özdemir H, Fitöz S, Çiftçi E, Yalçınkaya F Bone marrow aspiration complications: Iliopsoas abscess and sacroiliac osteomyelitis. Turk J Pediatr 2016;58:562-5.  Back to cited text no. 3
    
4.
Shah M, Watanakunakorn C Staphylococcus aureus sternal osteomyelitis complicating bone marrow aspiration. South Med J 1978;71:348-9.  Back to cited text no. 4
    


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