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Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review

BACKGROUND: Atopic eczema is a relapsing, itchy chronic cutaneous inflammatory disease that commonly affects children. The disease is often complicated by cutaneous infections such as eczema herpeticum, eczema vaccinatum and a varied number of bacterial infections – impetigo, cellulitis and erysipel...

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Autores principales: Masuka, Josiah T., Troisi, Katherine, Mkhize, Zamambo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996158/
https://www.ncbi.nlm.nih.gov/pubmed/32008574
http://dx.doi.org/10.1186/s12895-019-0098-0
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author Masuka, Josiah T.
Troisi, Katherine
Mkhize, Zamambo
author_facet Masuka, Josiah T.
Troisi, Katherine
Mkhize, Zamambo
author_sort Masuka, Josiah T.
collection PubMed
description BACKGROUND: Atopic eczema is a relapsing, itchy chronic cutaneous inflammatory disease that commonly affects children. The disease is often complicated by cutaneous infections such as eczema herpeticum, eczema vaccinatum and a varied number of bacterial infections – impetigo, cellulitis and erysipelas. However, rare case reports of infective endocarditis, otitis media and osteo-articular infections have been associated with atopic eczema. These associations possibly represent the extracutaneous infectious complications of atopic eczema. CASE PRESENTATION: Here we present two cases of osteomyelitis in HIV negative children with habitual scratching of poorly managed and/or uncontrolled atopic eczema respectively. Both cases presented to the orthopaedic surgeons and were admitted as acute phalangeal osteomyelitis and acute – on – chronic tibial osteomyelitis respectively. The first case was an 8 year old girl who had moderate-severe poorly-controlled atopic eczema and contiguously spread phalangeal osteomyelitis. The second case was an 11 year old pre-pubertal boy who had untreated atopic eczema and tibial osteomyelitis possibly from haematogenously spread Staphylococcus aureus infection. Both were successfully discharged from hospital and currently have well controlled eczema. The 11 year old patient is also being reviewed monthly by the orthopaedic surgeons and is chronic suppressive antibiotics. He may require sequestrectomy, should it be needed. CONCLUSIONS: Invasive staphylococcal and streptococcal osteo-articular (OA) infection can arise as an extra-cutaneous infectious complication of poorly controlled atopic eczema. It is more common in the 3 to 15 year age group and especially in boys with a septic arthritis to osteomyelitis ratio of around 29:5. Clinicians should maintain a high index of suspicion in patients with moderate-severe atopic eczema and they ought to promptly manage these OA infections with intravenous antibiotics to avoid further complications.
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spelling pubmed-69961582020-02-05 Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review Masuka, Josiah T. Troisi, Katherine Mkhize, Zamambo BMC Dermatol Case Report BACKGROUND: Atopic eczema is a relapsing, itchy chronic cutaneous inflammatory disease that commonly affects children. The disease is often complicated by cutaneous infections such as eczema herpeticum, eczema vaccinatum and a varied number of bacterial infections – impetigo, cellulitis and erysipelas. However, rare case reports of infective endocarditis, otitis media and osteo-articular infections have been associated with atopic eczema. These associations possibly represent the extracutaneous infectious complications of atopic eczema. CASE PRESENTATION: Here we present two cases of osteomyelitis in HIV negative children with habitual scratching of poorly managed and/or uncontrolled atopic eczema respectively. Both cases presented to the orthopaedic surgeons and were admitted as acute phalangeal osteomyelitis and acute – on – chronic tibial osteomyelitis respectively. The first case was an 8 year old girl who had moderate-severe poorly-controlled atopic eczema and contiguously spread phalangeal osteomyelitis. The second case was an 11 year old pre-pubertal boy who had untreated atopic eczema and tibial osteomyelitis possibly from haematogenously spread Staphylococcus aureus infection. Both were successfully discharged from hospital and currently have well controlled eczema. The 11 year old patient is also being reviewed monthly by the orthopaedic surgeons and is chronic suppressive antibiotics. He may require sequestrectomy, should it be needed. CONCLUSIONS: Invasive staphylococcal and streptococcal osteo-articular (OA) infection can arise as an extra-cutaneous infectious complication of poorly controlled atopic eczema. It is more common in the 3 to 15 year age group and especially in boys with a septic arthritis to osteomyelitis ratio of around 29:5. Clinicians should maintain a high index of suspicion in patients with moderate-severe atopic eczema and they ought to promptly manage these OA infections with intravenous antibiotics to avoid further complications. BioMed Central 2020-02-03 /pmc/articles/PMC6996158/ /pubmed/32008574 http://dx.doi.org/10.1186/s12895-019-0098-0 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Masuka, Josiah T.
Troisi, Katherine
Mkhize, Zamambo
Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review
title Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review
title_full Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review
title_fullStr Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review
title_full_unstemmed Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review
title_short Osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review
title_sort osteomyelitis complicating secondarily infected atopic eczema: two case reports and a narrative literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996158/
https://www.ncbi.nlm.nih.gov/pubmed/32008574
http://dx.doi.org/10.1186/s12895-019-0098-0
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