|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 106-107
Iliac crest osteomyelitis: A rare complication of bone marrow aspiration in a 12-year-old boy with aplastic anemia
Jahangir Ahmed Naseem1, CG Delhi Kumar1, Thirunavukkarasu Arun Babu2
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 Submission||12-May-2022|
|Date of Acceptance||14-Sep-2022|
|Date of Web Publication||19-Oct-2022|
Thirunavukkarasu Arun Babu
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri 522503, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|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. 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. 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. Recently, Tural-Kara et al. 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. 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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