Poststernotomy Osteomyelitis Presenting with Severe Sepsis and Rhabdomyolysis

Eugene M Tan,Kelly Cawcutt,Zelalem Temesgen,Melissa Lyle

doi:10.1155/2016/4507012

Eugene M Tan, Kelly Cawcutt + Show 2 more

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https://doi.org/10.1155/2016/4507012

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Abstract

A 39-year-old male, who recently underwent a composite valve graft of the aortic root and ascending aorta for bicuspid aortic valve and aortic root aneurysm, was hospitalized for severe sepsis, rhabdomyolysis (creatine kinase 29000 U/L), and severe liver dysfunction (AST > 7000 U/L, ALT 4228 U/L, and INR > 10). Cardiac magnetic resonance imaging (MRI) findings were consistent with sternal osteomyelitis with a 1.5 cm abscess at the inferior sternotomy margin, which was contiguous with pericardial thickening. Aspiration and culture of this abscess did not yield any organisms, so he was treated with vancomycin and cefepime empirically for 4 weeks. Because this patient was improving clinically on antibiotics and did not show external signs of wound infection, there was no compelling indication for sternectomy. This patient's unusual presentation with osteomyelitis and rhabdomyolysis has never been reported and is crucial for clinicians to recognize in order to prevent delays in diagnosis.

Highlights

Poststernotomy osteomyelitis is a complication of open heart surgery in 1–5% of patients [1] that typically presents as purulent sternocutaneous fistulas and is commonly treated with combined medical and surgical therapy, including antibiotics, partial or total sternectomy, excision of infected costal cartilage, and chest reconstruction using muscle flaps to fill the chest gap [2]
Cardiac magnetic resonance imaging (MRI) findings were consistent with sternal osteomyelitis with a 1.5 cm abscess at the inferior sternotomy margin (Figure 1), which was contiguous with pericardial thickening (Figure 2)
The incidence of osteomyelitis presenting with rhabdomyolysis is unknown, as there are no reports in the literature describing this presentation

Summary

Introduction

Poststernotomy osteomyelitis is a complication of open heart surgery in 1–5% of patients [1] that typically presents as purulent sternocutaneous fistulas and is commonly treated with combined medical and surgical therapy, including antibiotics, partial or total sternectomy, excision of infected costal cartilage, and chest reconstruction using muscle flaps to fill the chest gap [2]. The case illustrates a very unusual presentation that was treated nonsurgically

Case Presentation

Discussion