A 29-Year-Old Man with Sickle Cell Disease and Right Hip Pain

This case involves a 29-year-old man with sickle cell disease admitted for new, atypical right hip pain. History included frequent vaso-occlusive events, bilateral hip arthroplasty, and recent travel. While initial suspicion centered on a vaso-occlusive crisis, focal pain, elevated inflammatory markers (CRP: 100.6 mg/L; ESR: 113 mm/hr), leukocytosis (WBC: 15,680/µL), and D-dimer (3900 ng/mL) prompted evaluation for osteomyelitis. MRI revealed bone marrow edema of the right sacral ala with sacroiliac joint effusion. Blood cultures grew Campylobacter fetus, a rare invasive gram-negative pathogen often linked to gastrointestinal reservoirs in cattle and sheep. Diagnosis: C. fetus bacteremia with suspected sacral osteomyelitis and septic sacroiliitis. Treatment: 6-week antimicrobial course (initially meropenem, then ciprofloxacin based on MIC 0.25 µg/mL). Follow-up MRI showed marrow infarction, resolving effusion, and degenerative joint changes. Case highlights diagnostic challenges in differentiating osteonecrosis vs. osteomyelitis in sickle cell disease, and underscores importance of patient-reported pain nuances in clinical decision-making.

This case involves a 29-year-old man with sickle cell disease admitted for new, atypical right hip pain. History included frequent vaso-occlusive events, bilateral hip arthroplasty, and recent travel. While initial suspicion centered on a vaso-occlusive crisis, focal pain, elevated inflammatory markers (CRP: 100.6 mg/L; ESR: 113 mm/hr), leukocytosis (WBC: 15,680/µL), and D-dimer (3900 ng/mL) prompted evaluation for osteomyelitis. MRI revealed bone marrow edema of the right sacral ala with sacroiliac joint effusion. Blood cultures grew Campylobacter fetus, a rare invasive gram-negative pathogen often linked to gastrointestinal reservoirs in cattle and sheep. Diagnosis: C. fetus bacteremia with suspected sacral osteomyelitis and septic sacroiliitis. Treatment: 6-week antimicrobial course (initially meropenem, then ciprofloxacin based on MIC 0.25 µg/mL). Follow-up MRI showed marrow infarction, resolving effusion, and degenerative joint changes. Case highlights diagnostic challenges in differentiating osteonecrosis vs. osteomyelitis in sickle cell disease, and underscores importance of patient-reported pain nuances in clinical decision-making.