Suddenly Sidelined

By George Stinnett

Brooke Castleberry, 8, is always at the center of the action, whether it’s softball, swimming or martial arts. But last summer, the Virginia Beach girl was sidelined by a sudden, mysterious ailment.

Brooke’s mom and dad, Carolyn and John, were celebrating their anniversary with a night out when the cell phone rang. Brooke’s sister and brother wanted them to come home right away. The couple quickly returned to find Brooke crying uncontrollably from pain in her left hip and leg.

“I knew instinctively she needed CHKD,” Carolyn said. “We wouldn’t take her anywhere else.”

By the time they reached the CHKD emergency room near midnight on a Saturday, Brooke couldn’t walk at all. X-rays were taken and fluid from her left hip was sent to the lab. She was sedated to make her comfortable; antibiotics were started in case of an infection, and she was admitted to a nursing unit.

While the initial X-rays and lab tests didn’t provide a definitive diagnosis, several causes seemed possible. But it was important to be exact. So over the next 48 hours, more tests were ordered, including an MRI of her hip.

Those images provided a critical clue, and orthopedic surgeon Sheldon St. Clair provided the diagnosis: “Brooke had a severe infection in the hip joint, and a combination of surgery and antibiotics was needed to cure it.”

With that information in hand, Dr. St. Clair wanted to operate right away, that Tuesday night. The one-hour procedure involved opening the hip joint, which was like an abscess, draining the infection and irrigating the joint with antibiotic solution. Soon, Dr. St. Clair was telling the family all had gone well. Brooke’s physical relief was immediate, and she returned to her room to recuperate.

But there was a surprise yet to come. The next day they learned the infection was methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that causes common skin infections but also debilitating diseases once it gets into the body through breaks in the skin or contact with contaminated items. Being resistant to many antibiotics, MRSA is difficult to treat.

The Castleberrys don’t know how the infection got started, and they’d never heard of MRSA.

“Community-associated MRSA (versus the form acquired in a health care setting) is increasing,” said CHKD infectious disease specialist Randall Fisher. “Many more children locally are acquiring this ‘community strain,’ and it’s causing more serious, invasive infections. We’re concerned about the increase in antibiotic-resistant bacteria, so CHKD educates parents about the importance of using antibiotics only when truly needed.”

Brooke’s treatment regimen was changed to include stronger antibiotics. The surgery plus the new drugs began doing the job, and by the following Sunday, she could walk. And go home.


Brooke, left, with her sister Lindsay, 10

“Brooke was a trouper throughout,” her mom said. “We prayed a lot. And the nurses and child life staff were wonderful. Our friends from out of town couldn’t believe what they saw; they’d never experienced anything like CHKD.”

She continued IV antibiotics at home for six weeks and followed up with CHKD’s infectious disease specialists and Dr. St. Clair for several months.

Though she had to forgo last summer’s plans for her favorite sports and dance camps and swimming, she settled for magic camp and jewelry making. “I learned a lot of tricks and stuff,” Brooke said.

But now, she’s back on the field.

“We can’t thank Dr. St. Clair enough for what he did,” John said. “It’s terrible to see your child in pain.”

Dr. St. Clair says, “We’re fortunate to have the resources to help us make the difficult diagnoses and provide the best care. It takes a whole team.”

At CHKD, there’s no standing on the sidelines when a child is in need.

Dr. St. Clair practices with CHKD Surgical Group’s orthopedic and sports medicine practice. Dr. Fisher practices with Children’s Specialty Group PLLC at CHKD.

This story was featured in the second quarter 2006 issue of KidStuff, a publication of Children's Hospital of The King's Daughters.