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Acute hematogenous osteomyelitis of a closed fracture with chronic superinfection
1Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Abstract:
Acute hematogenous salmonella osteomyelitis is rare among immunocompetent adults. In this study, the authors reported an unusual case of salmonella enteriditis osteomyelitis of the humerus complicated by methicillin-resistant Staphylococcus aureus superinfection and eventual chronic osteomyelitis in an immunocompetent host. Resection of the humeral head and a significant portion of the humeral shaft coupled with numerous surgical debridements and intravenously administered antibiotics led to resolution of symptoms. This case provides a rare example of acute hematogenous osteomyelitis complicating a closed fracture and demonstrates the difficulty associated with eradication of these specific organisms while emphasizing the principle of aggressive surgical debridement in cases of chronic osteomyelitis.
Insights
Acute Salmonella osteomyelitis is rare in adults. This case highlights a Salmonella Enteritidis infection of the humerus, complicated by MRSA, requiring aggressive surgical intervention for resolution.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Acute hematogenous osteomyelitis is uncommon in immunocompetent adults.
- Salmonella species are a rare cause of osteomyelitis in this population.
Observation:
- A case of Salmonella Enteritidis osteomyelitis of the humerus in an immunocompetent adult is presented.
- The infection was complicated by a superinfection with methicillin-resistant Staphylococcus aureus (MRSA).
- The osteomyelitis developed subsequent to a closed humeral fracture.
Findings:
- The patient developed chronic osteomyelitis despite initial treatment.
- Aggressive surgical management, including resection of the humeral head and shaft, along with multiple debridements and intravenous antibiotics, led to symptom resolution.
- This case underscores the challenges in eradicating Salmonella and MRSA from bone tissue.
Implications:
- This case illustrates a rare instance of acute hematogenous osteomyelitis complicating a closed fracture.
- It emphasizes the critical role of aggressive surgical debridement in managing chronic osteomyelitis.
- The successful treatment highlights a potential therapeutic approach for complex bone infections involving resistant organisms.
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