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.