acute hematogenous escherichia coli osteomyelitis of the fibula in an adolescent girl

Introduction: acute hematogenous osteomyelitis (aho) usually occurs in the first two decades of life. evidence shows that 50% of patients with aho are younger than five years. this infection typically affects the metaphyseal region of long tubular bones, whereas the fibula is rarely involved. staphylococcus aureus is the causative agent of aho in the majority of cases, while escherichia coli is isolated rather uncommonly beyond the neonatal period. case presentation: herein, we describe the case of an adolescent girl who was treated medically and surgically for aho with an unusual location in the proximal fibula, caused by e. coli. the source of the causative agent remained unknown after the patient had been evaluated for possible urinary tract infection and underlying immune system defect. conclusions: the fibula is a rare anatomic location for aho, and such cases may pose a diagnostic challenge. lack of response to empiric antibiotic treatment in patients with aho may indicate the involvement of an uncommon pathogen, which is not susceptible to standard empiric antimicrobials aimed to target s. aureus as the most likely pathogen. in such instances, prompt surgical intervention can help determine the causative pathogen and optimize antimicrobial treatment.