[Oradlist] case for differential interpretation
tunderhill at verizon.net
Fri Sep 26 09:57:29 PDT 2008
Hello Dr. Nambiar,
I found the clinical history that you provided most useful. I would
say that this is a refractory hematogenous osteomyelitis. Management
should be from a combined medical and surgical approach.
First, infectious disease consult. Things to consider:
1. Initial presentation was with pain, fever, and positive blood
culture for G+ bacilli. The age of the patient is good for
hematogenous origin. Treatment with inappropriate antibiotics or
doses can result in disease extension, sequestra formation and the
development of refractory disease. I am not an infectious disease
expert, therefore I do not know if Gentamicin beads were an
2. I would repeat blood cultures (drawn from 2 separate sites to
exclude false positive from skin contamination). Do culture and
3. Once the offending organism is isolated, place PICC for long term
4. Follow serial sed rates to evaluate response to antibiotics.
Second, surgical consult.
From the CT, we know that portions of the central bone are dead,
i.e., large sequestra. We know that the periosteum is working over
time trying to out pace the infection. Removal of sequestra will tip
the battle in favor of the periosteum with regards to the chronic
infection. The cortical and cancellous bone remaining in the wound
must bleed uniformly to ensure antibiotic perfusion.
Given the patient's young age, with combined medical and surgical
intervention you may get a very good result and prevent loss of the
hemimandible or mandible.
Please share follow up examination in 6 months or a year from now if
you get them.
On Sep 25, 2008, at 4:37 AM, phrabha at um.edu.my wrote:
> Dear Colleagues,
> Attached herewith is a case of 12 year old child with a
> continuously growing jaw. This case was referred to me for a
> opinion. I have selected the appropriate images, including the CT
> images for your perusal. Please assist so that I do not miss
> anything .
> Thanking you.
> Phrabha Nambiar
> Faculty of Dentistry
> University of Malaya, Malaysia
> UNIVERSITY OF MALAYA - " Producing Leaders Since 1905 "
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> Oradlist at lists.ucla.edu
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