Multifocal osteomyelitis and abscess due to Bacteroides caccae in a child with sickle cell disease

BACKGROUND: Diagnosing osteomyelitis in pediatric patients with sickle cell disease (SCD) is challenging as bone pain is often attributed to vaso-occlusive episodes ("pain crisis"). Such episodes can result in bone infarcts which can subsequently become sites of infection. Among non-SCD patients, Staphylococcus species are the most common cause of osteomyelitis whereas Salmonella spp. are more frequently the causative organisms in SCD patients [1]. We report the first case of Bacteroides caccae osteomyelitis in a SCD pediatric patient. CASE PRESENTATION: Our patient is a 6-year-old non-verbal male with autism and SCD who presented with fever, headache and irritability and developed new onset back and neck pain during admission. He was subsequently diagnosed with Bacteroides caccae bacteremia complicated by multifocal osteomyelitis and L5/S1 spinal epidural abscess. He underwent left femur subperiosteal abscess irrigation and drainage and L5 bone biopsy. Pathology was consistent with acute osteomyelitis. He received long term Metronidazole with improvement in his condition. CONCLUSIONS: We report the first case of a child with autism and SCD who developed multifocal osteomyelitis and L5-S1 spinal epidural abscess due to Bacteroides caccae with an improvement after prolonged Metronidazole therapy.