Delayed Presentation of Pediatric Chronic Osteomyelitis of the Radius Following Cellulitis and a Prolonged Asymptomatic Period: A Case Report.

Pediatric cases of chronic osteomyelitis that remain asymptomatic for a prolonged period before becoming clinically evident are exceedingly rare. We report a rare case of pediatric chronic osteomyelitis of the left radius, which became clinically evident 1.5 years after an episode of left forearm cellulitis at the same anatomical site in a three-year-nine-month-old girl. The patient presented with fever, left wrist pain, and difficulty in flexing her left fingers. Plain radiography and magnetic resonance imaging (MRI) revealed osteolytic lesions spanning the distal radial metaphysis and epiphyseal nucleus across the epiphyseal line, consistent with a chronic disease course. She underwent emergency surgical debridement and lavage of the radius. Blood culture results revealed methicillin-susceptible Staphylococcus aureus, and antibiotic therapy was adjusted accordingly. Tuberculous osteomyelitis was excluded. The patient completed a six-week course of antibiotic therapy and remained recurrence-free, with no evidence of growth disturbance, during follow-up. The cellulitis resolved promptly with a one-week course of oral antibiotics, and the patient remained asymptomatic in the interim. This case underscores the importance of obtaining a careful history of prior skin infections at the same site when osteomyelitis is suspected, even when the infection appears to have resolved completely, and highlights the value of early MRI to facilitate prompt diagnosis given the potentially prolonged asymptomatic interval.