AIDS presenting as radial bone tuberculosis and pyogenic methicillin-sensitive Staphylococcus aureus osteomyelitis

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Immunology

Background:

• Osteomyelitis is an uncommon initial manifestation of human immunodeficiency virus (HIV).
• Prompt diagnosis and treatment are crucial for managing complex infections in immunocompromised individuals.

Observation:

• A 25-year-old male presented with a traumatic fracture of the right radius, accompanied by fever, swelling, and purulent discharge.
• Subsequent investigations revealed osteomyelitis, secondary bacteremia, and pneumonia, prompting HIV testing.
• Tissue cultures identified Mycobacterium tuberculosis (TB) and methicillin-sensitive Staphylococcus aureus.

Findings:

• The patient underwent surgical debridement, sequestrectomy, and vacuum-assisted closure.
• Successful treatment involved culture-guided antibiotics (oxacillin), anti-TB therapy, and later, antiretroviral agents.
• Limb functionality was preserved through a multidisciplinary team approach.

Implications:

• This case underscores the importance of considering rare infectious etiologies, including concurrent tuberculous and pyogenic osteomyelitis, in the differential diagnosis of patients presenting with severe infections and risk factors for HIV.
• Highlights the successful management of a complex dual infection in an HIV-positive individual, emphasizing the role of tailored, culture-guided antimicrobial therapy and comprehensive patient care.
• This report contributes to the literature as the first documented instance of adult HIV presenting with simultaneous tuberculous and pyogenic osteomyelitis of the radius.