Abstract
BackgroundFusobacterium species are uncommon causes of osteomyelitis. These organisms are normal flora of the oral cavity. Therefore, they mostly cause osteomyelitis of the head and neck. Hematogenous osteomyelitis at distant sites other than the head and neck has rarely been reported in pediatric or immunocompromised patients. Here, we report the first case of osteomyelitis of a long bone combined with a muscle abscess due to Fusobacterium nucleatum in an otherwise healthy adult.Case presentationA 59-year-old Korean man was admitted for pain and swelling of the right lower leg, which had been persistent for two weeks. Magnetic resonance imaging showed osteomyelitis of the right fibula with a surrounding muscle abscess of the right lower leg. Incision and drainage was performed, and repetitive tissue cultures grew F. nucleatum. In this patient, it was presumed that recurrent periodontitis caused hematogenous seeding of F. nucleatum to a distant site leading to osteomyelitis with a muscle abscess. The patient was successfully treated with intravenous ampicillin-sulbactam for three weeks and oral amoxicillin-clavulanate for eight weeks. He also underwent repeated surgical drainage. He has no evidence of recurrence after seven months of follow-up.ConclusionsClinicians should be aware that F. nucleatum could be the etiologic agent of hematogenous osteomyelitis of a long bone in an immunocompetent patient.
Highlights
Fusobacterium species are uncommon causes of osteomyelitis
Clinicians should be aware that F. nucleatum could be the etiologic agent of hematogenous osteomyelitis of a long bone in an immunocompetent patient
Anaerobes have traditionally been viewed as uncommon causes of osteomyelitis because they are difficult to isolate from infectious sites due to their fastidious nature
Summary
Fusobacterium species are gram-negative bacilli that are nonmotile, non-sporulating, obligate anaerobes from the family Bacteroidaceae [1]. About two weeks before this admission, he had been admitted to an outside hospital where he was found to have osteomyelitis of the right fibula combined with abscesses of adjacent muscles (soleus, tibialis posterior, and fibularis longus). He underwent incision and drainage of his right leg. The patient was transferred to our hospital for further diagnostic evaluation and treatment His past medical history was negative for diabetes mellitus, arterial hypertension, alcoholism, steroid use, and any other systemic infections. Computed tomography (CT) of the lower extremities at the outside hospital revealed osteomyelitis of the right fibula and a muscular abscess along the fibular shaft. His recovery has been uneventful without recurrence of infection after seven months of follow-up
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