{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:10:57Z","timestamp":1778217057514,"version":"3.51.4"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Limb necrosis in pediatric septic shock may serve as a persistent source of deep infection, but its role in hematogenous dissemination is underrecognized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 12-year-old boy with septic shock developed progressive left foot necrosis. This was followed by septic arthritis, multifocal osteomyelitis with extensive osteolytic destruction and pathological fracture of the femur, recurrent pneumothorax, and deep vein thrombosis, complicated by multidrug-resistant infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management strategies<\/jats:title>\n                    <jats:p>Source control was achieved via ultrasound-guided drainage of septic arthritis, pathogen-directed antibiotics, and multidisciplinary conservative management prioritizing medical treatment over high-risk surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinical stabilization occurred after more than 90 days of intensive care before transfer to a general ward.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates that limb necrosis in septic shock may precede disseminated osteomyelitis. Early bedside ultrasound and multidisciplinary source control are essential when deep infection is suspected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1762616","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:41:27Z","timestamp":1778215287000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Progressive limb necrosis as a portal to multifocal osteomyelitis in pediatric septic shock: a tissue-oriented management paradigm"],"prefix":"10.3389","volume":"14","author":[{"given":"Cheng","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Pediatric Intensive Care Unit Nursing, WCSUH-Tianfu\u00b7Sichuan Provincial Children's Hospital","place":["Meishan, China"]},{"name":"Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wansha","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit Nursing, WCSUH-Tianfu\u00b7Sichuan Provincial Children's Hospital","place":["Meishan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ximeng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit Nursing, WCSUH-Tianfu\u00b7Sichuan Provincial Children's Hospital","place":["Meishan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiawei","family":"Li","sequence":"additional","affiliation":[{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education","place":["Chengdu, China"]},{"name":"Department of 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