Inflammatory markers limitations in the diagnosis of pediatric calcaneal osteomyelitis.

Calcaneal osteomyelitis is an uncommon, but clinically important emergent condition in the differential of the limping child. Early recognition is paramount to prevent complications from delayed diagnosis like formation of periosteal abscesses or growth plate injury. The diagnosis of pediatric osteoarticular infection relies on a combination of clinical exam, imaging and inflammatory markers. Erythrocyte sedation rate (ESR) and C-reactive protein (CRP) have reported sensitivities for osteomyelitis of 94% and 95%, respectively. However, clinicians should be aware that certain clinical factors can decrease the reliability of inflammatory markers in this pediatric condition. Location of infection in small bones like the calcaneus can lead to significantly lower sensitivities than in long bones. Pretreatment with antibiotics prior presentation can also decrease the reliability of ESR and CRP. In this case, we highlight two unique clinical factors that diminish the sensitivity of commonly used inflammatory markers in the diagnosis of pediatric osteomyelitis.

Atraumatic Splenic Rupture After Weight Lifting in a Patient Presenting With Left Shoulder Pain.

We discuss a 23-year-old active duty male who presented to the emergency department with left shoulder pain after deadlifting heavy weights the day prior. His physical examination revealed a nontender and otherwise unremarkable left shoulder with full range of motion and mild tenderness to palpation in the left upper quadrant of the abdomen. A bedside focused assessment with sonography for trauma (FAST) examination showed free fluid in the abdomen and a computed tomography scan showed a splenic laceration and splenomegaly. He later tested positive for infectious mononucleosis. This is the first case report of atraumatic splenic laceration after heavy weight lifting. This case illustrates the importance of a broad differential and high index of suspicion in the patient with undifferentiated abdominal pain in order to diagnose a potentially fatal disease.