Multiple bone and joint disease in a sickle cell anaemia patient: a case report

Abstract

Objective: To further highlight the fact that bone involvement is the commonest clinical manifestation of SCD both in the acute settins such painful VOC and as a source of chronic , progressive debility such as AVN, chronic osteomyelitis and fixed flexion deformity of joints.

Protracted multiple bone involvement i.e. Bilateral femoral and left humeral chronic osteomyelitis, Left elbow, Left knee and right humeral septic arthritis together with aseptic necrosis of both femoral and right humeral heads, coupled with urinary tract infection((UTI) and decubitus ulcer in a young adult SCD patient at a stretch; is an unusual occurrence and deserves reporting and explanation. The determinant factors culminating in such heavy sepsis that resulted to an uninterrupted 29 weeks of hospital admission in this index patient, who had enjoyed fairly good health, deserves exploration.

Various micro-organisms were sequentially cultured at various times and sites; these include E coli and Klebsiella in urine and klebsiella spp cultured in the aspirates of the affected knee joint, elbow joint and femoral osteomyelitis.

Multidisciplinary approach was applied to her management and she was finally discharged home on a wheelchair. This case reflects not only the high susceptibility of SCD patients to infection, but also the morbidity and the attendant complications. It also highlights the need to forestall vaso-occlusive crisis (VOC) which often predisposes them to developing osteomyelitis. There is a need to have a highly organized, well-equipped and highly subsidized Sickle Cell and rehabilitation Center in order to further improve the care of SCD patients.