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We report a unique case of neonatal mycotic internal iliac artery aneurysm managed non-operatively. The child had multifocal osteomyelitis and no history of umbilical artery catheterisation. The aneurysm was regularly scanned and monitored until its obliteration by thrombus 17 days after initial detection. Contingency plans for either interventional radiological coiling or open surgical repair were in place had the aneurysm grown or the child deteriorated.

Acute osteomyelitis in neonates, although rare, represents a diagnostic and therapeutic challenge. We herein report an extremely rare case of congenital nonsyphilitic iliac bone osteomyelitis caused by methicilline-sensitive Staphylococcus aureus and presenting with gluteal syndrome in a near-term infant. To our knowledge, this represents the second report with iliac osteomyelitis and the first report with gluteal syndrome in neonatal period. A high index of suspicion is necessary to make an early diagnosis. Early diagnosis is essential to prevent catastrophic sequelae in such cases. We report this case because of its unusual clinical presentation and rarity.

We report an extremely rare case of congenital nonsyphilitic osteomyelitis in a very preterm infant, providing a unique illustration of the radiological appearances at birth, which may serve as a reference to facilitate diagnosis.

The neonate is unable to relate specific complaints of pain and may not exhibit the usual signs of illness or infection. Septic arthritis of the hip is a surgical emergency in the neonate, and it should be considered in any irritable or ill child who has a high index of suspicion. Prompt diagnosis and immediate treatment are necessary. Nearly all babies undergo routine examination of the hip for dysplasia. It is recognized that limitation of abduction of the hip in the neonate may not represent developmental dysplasia of the hip but may represent other etiologies, such as fracture, infection, congenital anomaly, or tumor. The following case report illustrates the importance of careful clinical evaluation of an apparent asymptomatic neonate.

A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from 1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 (range 27-40) weeks and mean birth weight 2269 (range 990-4750) gms. Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in 25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each). In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive blood culture. Klebsiella pneumoniae and Staphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics and open surgical drainage was done in 5 (20%) cases. Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management with antibiotics, surgical drainage in selected cases to prevent long term morbidity.

Ulnar clubhand is a rare deformity. In a patient with postnatal osteomyelitis of the ulna, the wrist had an ulnar deviation with marked ulnar slope of the radius. Good hand function precluded surgical correction.

Osteomyelitis has many forms of presentation in the pediatric age group. From neonatal osteomyelitis, with a paucity of clinical symptoms and signs, to the more typical acute hematogenous form or even the subacute or chronic presentations, a high index of suspicion is needed to institute appropriate investigations and treatment.

Gram-negative neonatal septicemia was diagnosed in a premature Standardbred colt. Clinical signs included lethargy, weakness, loss of suckle reflex, tachypnea, and injected mucous membranes. Sequelae included pneumonia, omphalophlebitis, septic arthritis, and osteomyelitis. Prepartum maternal uterine infection, premature delivery, abnormal parturition with premature fetal membrane separation, and failure of passive transfer of colostral immunoglobulins increased the foal's risk for developing sepsis. Treatment included administration of moxalactam disodium and cefadroxil. The clinical efficacy of cephalosporin antibiotics in the treatment of gram-negative sepsis is discussed.

A case of third generation early congenital syphilis with unusual features is reported and discussed. The infant presented with Livedo reticularis and an ulcer on the right forearm since birth; the underlying radius and ulna showed osteomyelitic changes with sequestrum formation and a pathological fracture. The rest of the skeletal system was normal. The blood STS (VDRL) was reactive at 1:64. The child showed no other evidence of congenital syphilis. Livedo reticularis and bony lesions resolved promptly with penicillin therapy, but abnormal movements at the wrist joint persisted. The mother had pathognomic Hutchinsonian incisors and a reactive VDRL test.

A newborn baby presented with hyaline membrane disease, interstitial pneumonia, jaundice, hepatosplenomegaly, and unusual bone manifestations with lytic and sclerotic bone lesions and virtually absent periosteal reaction. He subsequently developed intracranial calcifications and mental retardation. The pneumonia and hepatosplenomegaly resolved. At the time of the delivery, a sibling was suffering from a severe undetermined viral infection. The clinical evolution of the disease and the radiologic findings led us to believe that this patient had a prenatal viral infection. The laboratory tests and the histologic picture of the bone biopsy supported the diagnosis.