Question
My son, who is one year old, has had repeated episodes of septic arthritis of the left hip joint since he was 7 months of age. First time around, he received antibiotics (vancomycin and moncef) for a total of 8 weeks (3 Iv and 5 oral). However, within 3 months we noticed limitation of the movement and he was crying in pain. His joint was surgically drained and PCR for TB was done, which was positive. Synovial fluid culture showed staph albus. We were told that though bone TB is rare in such young children it can’t be ruled out completely. (my son was 2 months premature and his birth weight was 840 grams. Before the first episode of septic arthritis, he had spend around 3months in the hospital). We were also told that staph albus is usually non-pathogenic and a contaminant. However, within 15 days of starting ATT, he again had the same complain. His joint was again surgically drained. Tissue cultures and biopsy were done. These were negative for TB, fungal infection and again showed staph albus. Post surgery, spica was put on his leg. He was given IV antibiotics (teicoplannin) for 3 weeks and is currently on oral antibiotics (clindamycin). He has received 5 weeks of antibiotics so far. His plaster was removed a couple of days back but he is still not moving his leg. Questions are: 1) Can staph albus play such havoc? What should we do to ensure that there is no repeat of these incidents? 2) Post plaster, how much time does it take for infants to start moving their leg? Do infants experience stiffness post spica as adults? 3) what can i do to help my child recover and move his leg? 4) why is my son having these repeated episodes? I believe recurrence of septic arthritis is rare, then why is son having it so frequently?
Answer
Your son’s situation is highly unusual and I am afraid that I am not able to give much advice. I would be concerned that he suffers from a congenital immunodeficiency syndrome of some kind.
