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Article in Japanese

Acute onset of streptococcal calcaneal osteomyelitis with abscess formation

Hiroyuki KURODA1), Atsuo SATO1), Mana KOHARA1), Meiwa TOYOFUKU1), Hiroyuki SHIRO1)

This paper reports a case of streptococcal calcaneal osteomyelitis in a seven-year-old girl. Despite early appropriate antibiotic therapy, an abscess developed and the osteomyelitis became chronic. The patient visited Yokohama Rosai Hospital complaining of fever and right heel pain that had persisted for four days. Magnetic resonance imaging(MRI) revealed bone marrow edema in the right calcaneal bone and blood culture detected the presence of group Aβ -hemolytic Streptococcus; therefore, the patient was diagnosed with streptococcal calcaneal osteomyelitis. She was administered ampicillin intravenously, but the right heel pain and elevated hematological inflammatory markers persisted. On day 31, repeat MRI revealed an abscess in the right calcaneal bone. Abscess curettage was performed, and the right heel pain disappeared. The patient received antibiotic therapy for six months to treat the chronic osteomyelitis and she recovered with no sequelae. This case illustrates that acute osteomyelitis may become chronic despite the administration of early appropriate antibiotic therapy, and that repeated imaging exams, including MRI, are warranted in cases where clinical symptoms and signs persist.

1) Department of Pediatrics, Children's Center, Yokohama Rosai Hospital,
Japan Organization of Occupational Health and Safety

Key words group Aβ-hemolytic Streptococcus, calcaneal osteomyelitis, acute osteomyelitis, abscess, chronic osteomyelitis
Received May 25, 2017
Accepted December 21, 2017

29 (4):357─361,2018