Ischiopubic synchondrosis osteomyelitis: a rare presentation of a limping child presenting to a paediatric emergency department.

We present a case of a middle childhood boy who presented to our paediatric emergency department with severe right upper thigh pain, radiating to inguinal/hip area. The pain was sharp in nature, described like a severe cramp which started 10 hours prior to presentation, progressively increasing over time. He denied any recent trauma or infective symptoms, and there were no other associated complaints. On physical examination, he was in tears due to excruciating pain which he could not locate precisely, had tense muscles at the right posterior upper thigh and lower gluteal area and had limping. Also, he had mild right testicular tenderness on examination which he did not complain of before, no skin changes or swelling with normal cremasteric reflex. His investigations were significant for asymmetric ischiopubic synchondrosis on pelvic X-ray. Scrotal ultrasound showed no evidence of testicular torsion. Pelvic MRI showed features consistent with the right ischiopubic synchondrosis osteomyelitis. He spiked a high-grade fever of 40°C within 24 hours of presentation. His blood culture grew methicillin-sensitive Staphylococcus aureus On admission, he was managed initially with ceftriaxone, vancomycin and clindamycin. After the blood culture result, he received ceftriaxone for 2 weeks, followed by oral cefuroxime for another 2 weeks. Pain controlled with ketorolac and paracetamol. Our patient was diagnosed and started on antibiotics within 24 hours from presentation.