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Trichophyton rubrum osteomyelitis after calcaneus external fixation pin stabilization of a pilon fracture
Gregory R Waryasz1, Jason T Bariteau1
1Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, RI.
Abstract:
Fungal organisms are an uncommon cause of osteomyelitis, and no dermatophyte osteomyelitis infections have been reported in published studies. We present the case of Trichophyton rubrum osteomyelitis of the calcaneus. Our patient initially presented with a pilon fracture requiring temporary external fixation while awaiting definitive fixation. From our review of the published data, the present case is the first of this type of fungal osteomyelitis to be reported. The patient was evaluated for a left neck mass during his hospitalization that was later found to be consistent with salivary duct carcinoma of the tail of the parotid gland. A left neck dissection and superficial excision of the parotid gland was performed after fixation of his pilon fracture. Subsequently, he developed an increasing lucency in the calcaneus and symptoms of pain and erythema months after the calcaneus pin had been removed. The osteomyelitis was treated with surgical debridement and 3 months of itraconazole once cultures had definitively grown T. rubrum.
Insights
This is the first reported case of osteomyelitis caused by Trichophyton rubrum, a type of dermatophyte. The fungal infection of the calcaneus bone was successfully treated with surgery and antifungal medication.
Area of Science:
- Mycology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Osteomyelitis, a bone infection, is rarely caused by fungi.
- Dermatophyte infections of the bone have not been previously documented in scientific literature.
- Fungal osteomyelitis presents unique diagnostic and therapeutic challenges.
Observation:
- A patient with a calcaneal fracture developed secondary osteomyelitis.
- Cultures confirmed the causative agent as Trichophyton rubrum, a dermatophyte.
- The patient also underwent treatment for salivary duct carcinoma.
Findings:
- This case represents the first documented instance of Trichophyton rubrum osteomyelitis.
- The infection localized to the calcaneus (heel bone).
- Successful treatment involved surgical debridement and a 3-month course of itraconazole.
Implications:
- Highlights the potential for dermatophytes to cause deep-seated bone infections.
- Suggests considering fungal etiologies in recalcitrant osteomyelitis cases, especially in immunocompromised individuals or those with specific risk factors.
- Emphasizes the importance of thorough microbiological investigation in complex orthopedic infections.
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