A Persistent Neck Pain

Osteomyelitis is an osteoarticular infection wich is more common in boys below 5 year-old, with non-specific clinical and laboratorial features. Staphylococcus aureus is the main pathogen at all ages.

A previously healthy 10 year-old girl, basketball player, who presented with 3 days fever, cough, vomits and neck pain for a few months, that worsened in the days before the admission, without relief factors and no history of trauma. The physical examination revealed right trapezius muscle contracture with painful palpation, painful cervical mobilization, cervical hyperextension position and neck stiffness. The laboratory work-up was unremarkable (including negative hemoculture) except for the elevated PCR (16.02mg/dL). For persistent fever, vomits and significant cervical pain she performed contrasted cervical and thoracic spine MRI that showed vertebral osteomyelitis (C7-D1). She completed empirical parenteral treatment with flucloxacilin and clindamycin for 14 days with apyrexia in 48h, PCR decrease (3.12mg/dL) and cervical pain and mobilization improvement. After hospitalar discharge she completed 4 more weeks with oral flucloxacilin.

Osteomyelitis can be difficult to diagnose and demands a high index of suspicion. Pain is usually significant and the most common symptom. The vertebral involvement is rare and occurs more often in older children and adolescents. The appropriate therapy is essential to avoid complications and long-term sequelae.