Abstract
This article presents a 19-year old patient with a distal femoral osteosarcoma treated with limb salvage and distal femoral megaprosthetic reconstruction complicated postoperatively by bone leishmaniasis. Bone biopsy was done; bone tissue was sent for cultures and histology. Cultures were negative. Histological sections showed Leishman - Donovan bodies within histiocytes confirming the diagnosis of leishmania infection of the distal femoral megaprosthesis. The patient was administered amphotericin B for a total of 10 days and gradually became afebrile. Two months after treatment the patient was readmitted with high fever, pancytopenia, liver and spleen enlargement, and chest pain. Radiographs of the chest showed lobar pneumonia and pleural effusion; thoracentesis showed Mycobacterium avium intracellulare lung infection. Despite multi-regimen antibiotic therapy and chemotherapy, disease progressed and the patient died 19 months after osteosarcoma resection and distal femoral megaprosthetic reconstruction from cancer-related complications.
Highlights
The most common complications of limb salvage surgery and megaprosthetic reconstruction are mechanical failure, infection and local recurrence [1,2]
This article presents a 19-year old patient with a distal femoral osteosarcoma treated with limb salvage and distal femoral megaprosthetic reconstruction complicated postoperatively by bone leishmaniasis
Leishmaniasis is a disease caused by protozoan parasites that belong to the genus Leishmania and is transmitted by the bite of certain species of sand fly, as was probably the case in the present patient
Summary
The most common complications of limb salvage surgery and megaprosthetic reconstruction are mechanical failure, infection and local recurrence [1,2]. This article presents a 19-year old patient with a distal femoral osteosarcoma treated with limb salvage and distal femoral megaprosthetic reconstruction complicated postoperatively by bone leishmaniasis. The patient responded favorably to neo-adjuvant chemotherapy with tumor shrinkage and disappearance of pulmonary nodules, and underwent distal femoral resection and megaprosthetic reconstruction.
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