Abstract:
BACKGROUND:Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors. CASE PRESENTATION:A woman aged 52 years with no history of trauma presented with severe pain, swelling, and increased local heat in the proximal area of the right knee 3 weeks after she first noticed discomfort. Magnetic resonance imaging showed persistent osteomyelitis of the distal metaphysis and diaphysis of the femur with a multifocal intraosseous abscess pocket. An incision and drainage of the abscess were conducted. The tissue culture, fungus culture, acid fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was successfully treated with intravenous penicillin G for 8 weeks followed by oral amoxicillin-clavulanate for 6 weeks with repeated surgical debridement and drainage. After a 5-year follow up, the patient had no signs of recurring infection or complications and she had full range of movement in the affected knee. CONCLUSIONS:Although rare, actinomycotic osteomyelitis can occur in healthy people. Furthermore, actinomycotic osteomyelitis is easily misdiagnosed as tuberculosis in areas with a high prevalence of tuberculosis. To detect and identify the bacteria accurately, pathologic examination should be performed as well as culture tests, because the probability for culture confirmation of actinomycosis is quite low. The initial treatment is vital to a successful outcome without ostectomy or amputation.
journal_name
BMC Musculoskelet Disordjournal_title
BMC musculoskeletal disordersauthors
Ryu DJ,Jeon YS,Kwon HY,Choi SJ,Roh TH,Kim MKdoi
10.1186/s12891-019-2576-2subject
Has Abstractpub_date
2019-05-01 00:00:00pages
185issue
1issn
1471-2474pii
10.1186/s12891-019-2576-2journal_volume
20pub_type
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journal_title:BMC musculoskeletal disorders
pub_type: 杂志文章
doi:10.1186/1471-2474-2-2
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journal_title:BMC musculoskeletal disorders
pub_type: 杂志文章,多中心研究
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pub_type: 临床试验,杂志文章
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journal_title:BMC musculoskeletal disorders
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journal_title:BMC musculoskeletal disorders
pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:BMC musculoskeletal disorders
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2015-02-13 00:00:00
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doi:10.1186/s12891-019-2875-7
更新日期:2019-11-03 00:00:00
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journal_title:BMC musculoskeletal disorders
pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
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更新日期:2016-04-29 00:00:00
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journal_title:BMC musculoskeletal disorders
pub_type: 临床试验,杂志文章
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