Differential diagnosis of osteomyelitis in children and adolescents

Condition	Features that distinguish from osteomyelitis
Other infections
Septicemia Cellulitis Septic arthritis Deep abscess Pyomyositis Garré sclerosing osteomyelitis Congenital syphilis	MRI or scintigraphy studies lack abnormalities characteristic of osteomyelitis
Noninfectious conditions
Chronic nonbacterial osteomyelitis (eg, CRMO)	Multifocal lesions on imaging studies Lack of response to antimicrobial therapy
Malignancy (eg, primary bone tumor, leukemia)	Intermittent symptoms Lack of response to antimicrobial therapy Characteristic histopathology
Bone infarction in patients with hemoglobinopathy	Improvement with hydration and other supportive measures
Vitamin C deficiency (scurvy)	Dietary history of limited vitamin C intake (eg, restricted feeding behavior in children with autism spectrum disorder) Petechiae, ecchymoses, bleeding gums, coiled hair, hyperkeratosis
Gaucher disease	Characteristic radiographic features Dysmorphic features on examination
Complex regional pain syndrome	Autonomic dysfunction Normal erythrocyte sedimentation rate, C-reactive protein
Neuropathic arthropathy (Charcot foot)	Usually involves multiple bones of the midfoot
Caffey disease (infantile cortical hyperostosis)	Characteristic histopathology
Radiographic mimics*
Benign bone tumors: Fibrous dysplasia Osteoid osteoma Osteoblastoma Chondroblastoma Chondromyxoid fibroma	Absence of acute symptoms Lack of response to antimicrobial therapy Characteristic histopathology
Langerhans cell histiocytosis	Characteristic histopathology
Malignant bone tumors: Osteosarcoma	Intermittent symptoms Lack of response to antimicrobial therapy Characteristic histopathology

MRI: magnetic resonance imaging; CRMO: chronic recurrent multifocal osteomyelitis.

* Refer to UpToDate topics on benign bone tumors, Langerhans cell histiocytosis, and malignant bone tumors for additional information about the radiographic appearance of these conditions.

Graphic 96520 Version 5.0

خرید پکیج

Differential diagnosis of osteomyelitis in children and adolescents