Abstract
BackgroundMycobacterium haemophilum is a slow-growing, fastidious, iron-requiring microorganism that, relative to other non-tuberculous mycobacterial species, has rarely been documented as a cause of human infection. This microorganism appears to be acquired via environmental exposure although its natural habitat and mode of acquisition are unknown. It has primarily been implicated as a cause of ulcerating cutaneous or subcutaneous nodular skin lesions, particularly in immunocompromised patients, although infections at extracutaneous sites have also been described. Osteomyelitis, while rarely documented, appears to be an important complication of infection with M. haemophilum in these patients.Case presentationWe describe a unique case of culture-confirmed M. haemophilum osteomyelitis in an adult woman with polycythemia vera and review the world literature on bone infections due to this organism.ConclusionMycobacterium haemophilum is an important but infrequently encountered cause of osteomyelitis in immunocompromised patients, often requiring months to years of medical therapy, with or without surgery, to effect a clinical cure.
Highlights
Mycobacterium haemophilum is a slow-growing, fastidious, iron-requiring microorganism that, relative to other nontuberculous mycobacterial species, has rarely been documented as a cause of human infection. This microorganism appears to be acquired from environmental exposure its natural habitat and mode of acquisition are unknown
It has primarily been implicated as a cause of ulcerating cutaneous or subcutaneous nodular skin lesions, in immunocompromised patients, infections at extracutaneous sites have been described
We report a case of M. haemophilum osteomyelitis in a patient with polycythemia vera and provide a summary review of the world literature on M. haemophilum bone infections
Summary
Mycobacterium haemophilum is a slow-growing, fastidious, iron-requiring microorganism that, relative to other nontuberculous mycobacterial species, has rarely been documented as a cause of human infection This microorganism appears to be acquired from environmental exposure its natural habitat and mode of acquisition are unknown. BMC Infectious Diseases 2006, 6:70 http://www.biomedcentral.com/1471-2334/6/70 fast bacilli (AFB) She had lived in Canada for most of her adult life aside from yearly, extended vacations in Arizona, USA. X-rays demonstrated osteolysis of the distal tibia consistent with osteomyelitis She developed gastrointestinal intolerance to ciprofloxacin and rifabutin, and was continued on clarithromycin alone. After 1 and 6 weeks, respectively, growth of acid-fast bacilli was observed only on the hemin-supplemented Middlebrook slants inoculated with the wrist and ankle specimens and definitively identified as M. haemophilum by high-performance liquid chromatography (Laboratoire de sante publique du Quebec, Montreal, Canada). She improved after 2 years of clarithromycin therapy, with plans to continue therapy indefinitely until there was radiologic evidence of bony healing, she eventually died of transformation to acute leukemia
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