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.
J Orthop Case Rep
Dehority W, Silva S, Muller M. Nosocomial Chronic Osteomyelitis of the Tibia in an Otherwise Healthy Adolescent: A Case Report. J Orthop Case Rep. 2019;9(4):71-75. doi: 10.13107/jocr.2019.v09.i04.1486. PMID: 32405493; PMCID: PMC7210920.