Not by the Red on My Chinny Chin Chin: A Case of Mandibular Osteomyelitis in a 5-Year-Old Girl

Abstract Background Osteomyelitisis not an uncommon emergency department diagnosis in pediatric patients, and most cases are in the lower extremities. Children can present with acute, subacute, or chronic erythema, pain, swelling, or decreased use of the extremity; some patients will also have fever or elevated serum inflammatory markers, or both. Case Report We present the case of a healthy 5-year-old girl who presented to the emergency department with 3 weeks of painless chinswelling and 2 days of erythemaand pain. While laboratory testing was normal, magnetic resonance imaging demonstrated osteomyelitisof the mandible, later confirmed by biopsy. After 4 weeks of intravenous antibiotics and an additional 2 weeks of oral antibiotics, the patient recovered completely without any residual findings. Why Should an Emergency Physician Be Aware of This? This case demonstrates that osteomyelitiscan develop in previously healthy, fully vaccinated children with competent immune systems. Systemic findings (ie, fever and elevated serum inflammatory markers) may be absent, and osteomyelitisshould always be considered in the differential diagnosis for a child presenting with subacute to chronic cutaneous findings without other clear explanation.