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Clinical Findings of Dubey et al Seen in Patients with Recurrent Osteomyelitis

Description

Dubey et al described the clinical findings seen in pediatric patients with recurrent osteomyelitis. These findings can help identify a patient who should undergo further diagnostic studies. The authors are from Bellevue Hospital Center and New York University Medical Center in New York City.


 

Most common findings::

(1) development of a drainage or discharge, which may be purulent (64%)

(2) swelling (47%)

(3) pain (42%)

 

Findings seen in less than a third of patients:

(1) fever

(2) tenderness

(3) erythema

(4) new onset or worsening of limp or other loss of function

 

Laboratory findings:

(1) mild increase in the WBC count (up to 17,000 per µL)

(2) ESR > 30 mm/h

 

It is not uncommon for patients to have relatively unremarkable laboratory tests and the diagnosis should not be excluded because the ESR and/or WBC counts are normal. 58% of patients had a white blood cell count < 10,000 per µL, and 38% of patients had an ESR < 30 mm/h. A quarter of patients had both a WBC count < 12,000 per µL and an ESR < 30 mm/h.

 

Diagnosis requires:

(1) knowledge about the past episode(s) of osteomyelitis

(2) identification of potential risk factors

(3) a high index of clinical suspicion

 


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