Acute Osteomyelitis of Scapula: An Unusual Complication of Untreated Scabies in a Child

To the Editor: A 12-y-old boy presented with fever, swelling and painful restriction of right shoulder movement for four days. There was no history of trauma, involvement of other joints, loss of appetite or weight. He also had generalized itching for one month. Rest of the history was normal. On examination, there was a tender, fluctuant swelling (6 × 6 cm) over the supero-posterior shoulder extending to the scapula. Painful restricted movements at the shoulder joint were noted. His skin had multiple crusted scabies lesions and scratch marks. Investigations showed neutrophilic leukocytosis and elevated C-reactive protein. Ultrasound of the right shoulder region revealed an organized pus collection which was drained. Magnetic resonance imaging of the right shoulder showed osteomyelitis of the spine of the scapula and the acromio-clavicular joint. Cultures from the skin swabs, pus and blood grew methicillin-resistant Staphylococcus aureus (MRSA). Based on culture results, intravenous vancomycin and clindamycin were given for four weeks. He was treated twice with permethrin cream 5% for scabies and was discharged on day 32 of admission. On follow-up after two months, the child was asymptomatic with normal right shoulder movements. …