Background: Atopic eczema is a relapsing, itchy chronic cutaneous inflammatory disease that commonly affects\nchildren. The disease is often complicated by cutaneous infections such as eczema herpeticum, eczema vaccinatum\nand a varied number of bacterial infections â?? impetigo, cellulitis and erysipelas. However, rare case reports of\ninfective endocarditis, otitis media and osteo-articular infections have been associated with atopic eczema. These\nassociations possibly represent the extracutaneous infectious complications of atopic eczema.\nCase presentation: Here we present two cases of osteomyelitis in HIV negative children with habitual scratching\nof poorly managed and/or uncontrolled atopic eczema respectively. Both cases presented to the orthopaedic\nsurgeons and were admitted as acute phalangeal osteomyelitis and acute â?? on â?? chronic tibial osteomyelitis\nrespectively. The first case was an 8 year old girl who had moderate-severe poorly-controlled atopic eczema and\ncontiguously spread phalangeal osteomyelitis. The second case was an 11 year old pre-pubertal boy who had\nuntreated atopic eczema and tibial osteomyelitis possibly from haematogenously spread Staphylococcus aureus\ninfection. Both were successfully discharged from hospital and currently have well controlled eczema. The 11 year\nold patient is also being reviewed monthly by the orthopaedic surgeons and is chronic suppressive antibiotics. He\nmay require sequestrectomy, should it be needed.\nConclusions: Invasive staphylococcal and streptococcal osteo-articular (OA) infection can arise as an extracutaneous\ninfectious complication of poorly controlled atopic eczema. It is more common in the 3 to 15 year age\ngroup and especially in boys with a septic arthritis to osteomyelitis ratio of around 29:5. Clinicians should maintain\na high index of suspicion in patients with moderate-severe atopic eczema and they ought to promptly manage\nthese OA infections with intravenous antibiotics to avoid further complications.
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