Osteomyelitis in adults: An underrecognized clinical entity in immunocompetent hosts. A report of six cases

Abstract

Objective Osteomyelitis is rare in adults and typically occurs in patients with risk factors such as sickle cell disease or immune deficiency. Cases in immunocompetent adults without sickle cell disease are extremely rare. The objective of this work was to describe the epidemiological, clinical, laboratory, and radiological features and the management of long-bone osteomyelitis in immunocompetent adults without sickle cell disease. Methods We conducted a retrospective descriptive study of all immunocompetent adults without sickle cell disease who were admitted to our center between November 2002 and November 2008 for long-bone osteomyelitis. In all patients, the clinical symptoms started in adulthood, in the absence of a childhood history of osteomyelitis. Results We identified six patients meeting our inclusion criteria over the 6-year study period. The causative microorganism was methicillin-susceptible Staphylococcus aureus in four patients and Salmonella in two patients (wild-type S. typhi and S. enterica, respectively). In each patient, there was a single focus of osteomyelitis and a single causative microorganism. The symptoms developed insidiously and lacked specificity. At presentation, the patients had moderate pain with or without a swelling. There was no fever initially in five patients, three of whom had major diagnostic delays as a result. Treatment associated antibiotics and surgery in all patients and the initial outcome was consistently favorable (median follow-up: 15 months; range: 8–72). Conclusion Osteomyelitis can occur even in immunocompetent adults. The protracted course and atypical presentation of osteomyelitis in immunocompetent adults may lead to major diagnostic delays.