Chronic multifocal Mycobacterium fortuitum osteomyelitis following penetrating plantar trauma

We present the case of a 10-year-old girl with Mycobacterium fortuitum osteomyelitis following a plantar puncture wound with vegetative material. Nontuberculous mycobacterial (NTM) skin and soft tissue infections are well described in immunocompromised populations. However, NTM infection can also be seen in healthy hosts following direct inoculation. Magnetic resonance imaging examination demonstrated multifocal midfoot and metatarsal osteomyelitis. Surgical exploration revealed caseation necrosis and a chronic draining sinus tract. Combined surgical debridement and medical therapy resulted in clinical cure. A high index of suspicion and adequate collection and handling of surgical specimens facilitate the diagnosis and treatment of NTM skin and soft tissue infections.