Letter to the Editor Possible Campylobacterjejuni osteomyelitis in a 14-month-old child

A 14-month-old girl without predisposing factors presented to the hospital with a 2-day history of limping and fever. The child had one liquid stool 6-7 days before hospitalization. She had fallen from a slide 3 days before admission. On admission, the patient was febrile, and had exquisite tenderness and swelling of the left knee. The initial white blood cell (WBC) count was 15.6~ 109/L (38.6% neutrophils); the C-reactive protein (CRP) level and the erythrocyte sedimentation rate (ESR) were 9.3 mg/dL and 82 mm/h respectively. X-ray of the knee showed an osteolytic lesion in the right distal femur close to the metaphysis (Brodie abscess), with moderate soft tissue edema. Bone scintigraphy with technetium-99m showed intense increased uptake in the region of the lytic lesion seen on the X-ray. A provisional diagnosis of distal femoral osteomyelitis was made. The patient was treated empirically with intravenous cefotaxime (25 mg/kg every 6 h) and oxacillin (25 mg/kg every 6 h). Blood cultures obtained before the initiation of antibiotics yielded Campylobacter jejuni HS 15 phage type 8. Stool cultures obtained after the initiation of antibiotic treatment were negative. The organism was susceptible by disk diffusion to ampicillin, amoxicillinclavulanate, ofloxacin, chloramphenicol, and erythromycin. E test for ampicillin, amoxicillin and erythromycin revealed minimal inhibitory concentrations (MICs) of 8, 6 and 3 ug/mL respectively. Antibiotic treatment was changed to parenteral ampicillin (50 mg/kg every 6 h) and oral clarithromycin (10 mg/kg every 12 h) on the basis of culture results and sensitivity testing. The patient’s pain and limping improved within the first days of therapy. The leukocyte count and CRP value returned to normal after 5 days. The ESR decreased to 39 mm/h. After 3 weeks of parenteral antibiotic therapy, all biological markers were normal. The child’s regimen