Chronic bacterial osteomyelitis of the clavicle secondary to pectoralis major pyomyositis in a child: A case report

Introduction and importance

Chronic bacterial osteomyelitis of the clavicle is rare in children. It mainly results from hematogenous spread of the infection and exceptionally from a non-hematogenous origin.

Case presentation

A 11-year-old boy was admitted for two wounds in right clavicular and pectoral regions, evolving for weeks. He had history of right pectoralis major pyomyositis debridement 6 months ago. Initial X-rays did not identify any bone anomaly. After initial antibiotic treatment, he discontinued his follow-up and came up 3 months later, with a pus discharging fistula in the right pectoral region, with X-ray identifying a sequestrum over the right clavicle. After pus culture, a Pseudomonas aeruginosa-sensitive antibiotic treatment was conducted, with surgical treatment (fistulectomy and sequestrectomy). The postoperative course was unremarkable.

Clinical discussion

In children, osteomyelitis affects usually long bones. Its location on the clavicle is rare, but mainly due to a hematogenous spread. Infection from previous pectoralis major pyomyositis can occur due to its clavicular head, it is an exceptional mechanism.

Conclusion

Bacterial chronic osteomyelitis of the clavicle is rare, its origin from pectoralis major pyomyositis is even exceptional. However rarely reported, infection may be linked to Pseudomonas aeruginosa.