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Uncommon Kingella kingae lytic bone lesions in children

Kingella kingae has emerged as an important cause of osteoarticular infections (OAI) in young children, ranging from 48 to 82%, as a result of improved culture methods and nucleic acid amplification techniques. Usually these infections are mild and have a favorable prognosis, but severe infections have been reported. Mallet et al. conducted a retrospective study and identified 10 unusual K. kingae OAI with bony lytic lesions and growth cartilage damage. We also report three patients with these atypical lesions. From 2012 to 2014, three children (Table 1) withK. kingae lytic OAI were identified. All had low-grade fever, mild ankle or feet tumefaction and refusal to bear weight. The gap between symptom onset and admission was 12 ± 6 days. Two reported previous upper respiratory illness. All had slightly elevated inflammatory markers (average: leukocytes, 8900 cells/mm; sedimentation rate, 32.3 mm/h; C-reactive protein, 1.93 mg/dL). Each had a single lytic lesion: in the posterior talus (Fig. 1a); in the postero-inferior tubercle of calcaneus, with liquid collection and thickening of adjacent plantar fat pad (Fig. 1b); and in the distal lateral metaphyseal peroneus, with peri-maleolar soft-tissue thickening and ankle effusion (Fig. 1c).