Document Type

Article

Publication Date

1-1-2019

Abstract

INTRODUCTION: Pseudomonas osteomyelitis in otherwise healthy children is rare but may present following puncture wounds to the foot or involve the skull following mastoiditis. We present a case of nosocomial chronic osteomyelitis of the tibia caused by Pseudomonas in a previously healthy adolescent following surgical debridement of a non-pseudomonal chronic osteomyelitis in the same location 18 months prior. To our knowledge, such a case has not previously been described.

CASE REPORT: A 17-year-old previously healthy young man presented with several month duration of pain in the right leg below the knee with no prior trauma, overlying a site of chronic, culture-negative osteomyelitis which was successfully treated with anti-staphylococcal therapy 1year prior. Magnetic resonance imaging of the affected area revealed findings consistent with chronic osteomyelitis at his prior surgical site, while operative culture demonstrated growth of a multidrug-resistant Pseudomonas aeruginosa. An extensive immunological evaluation was unremarkable. He demonstrated clinical and radiographic improvement following 4 months of intravenous antimicrobial therapy.

CONCLUSION: Given the extreme rarity of P.aeruginosa in community-acquired osteoarticular infections, as well as the antimicrobial resistance profile demonstrated and the localization to a prior surgical site, this is felt to be the first description of a nosocomial osteoarticular infection with this organism in an otherwise healthy child. Providers should be aware of the potential for osteoarticular infection with atypical organisms in the post-operative patient.

Publication Title

J Orthop Case Rep

ISSN

2250-0685

Volume

9

Issue

4

First Page

71

Last Page

75

DOI

10.13107/jocr.2019.v09.i04.1486

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