A rare case of osteomyelitis caused by erysipelothrix rhusiopathiae

Abstract

Erysipelothrix rhusiopathiae is a nonmotile, nonspore-forming, facultative anaerobic, gram positive rod commonly found in nature. It rarely causes disease in humans and usually occurs as localized skin infections associated with occupational disease. Although E. rhusiopathiae is mentioned as a rare infection agent in orthopedic literature, the reports of the last decade show that is considered to be one of the bacterial agent for reactive arthritis, osteomyelitis, prosthetic infection and spondylitis. In this case report, we present a case of osteomyelitis which is caused by E. rhusiopathiae in a patient with diabetes mellitus and hypertension. A 65-year-old woman with type 2 diabetes and hypertension was referred to the wound care unit with a wound that occured with an unknown reason three months before. Radiologically, direct gross appearance of the patient showed osteomyelitis-compatible appearance in the bone tissues beneath the wound-compatible region. E. rhusiopathiae was identified as a result of mass spectrophotometry after 48 hours in the bone tissue culture taken from the patient after debridement. Patient recovered with the completion of the treatment ampicillin-sulbactam 1X500 mg / day intramuscularly.

Keywords

• Erysipelothrix rhusiopathiae,zoonoses,occupational disease,soft tissue disorder,osteomyelitis

Erysipelothrix rhusiopathiae’nın etken olduğu nadir bir osteomiyelit olgusu

Öz

Erysipelothrix rhusiopathiae doğada yaygın olarak bulunan hareketsiz, sporsuz, fakültatif anaerob, gram pozitif basildir. İnsanlarda nadiren hastalık yapar ve genellikle meslek hastalığı ile ilişkili olarak lokalize deri enfeksiyonları şeklinde görülür. Ortopedik literatürde nadiren enfeksiyon etkeni olduğundan bahsedilse de son on yıldaki raporlar, E. rhusiopathiae'nin reaktif artrit, osteomiyelit,  prostetik enfeksiyon ve spondilit için bakteriyel etkenlerden biri olarak kabul edildiğini göstermektedir. Bu olgu sunumunda diabet ve hipertansiyonu bulunan hastada E. rhusiopathiae’nın etken olduğu osteomiyelit vakası sunulmaktadır. Tip 2 diabetes mellitus ve hipertansiyonu olan 65 yaşında kadın hasta üç ay öncesinde sağ ayak topuğu medial bölgesinde hatırlayamadığı şekilde ortaya çıkan ve iyileşmeyen yara nedeni ile yara bakım birimine yönlendirildi. Radyolojik olarak hastanın direkt grafisinde yaranın bulunduğu bölge altındaki kemik dokularda osteomiyelit ile uyumlu görünüm izlendi. Debridman sonrası hastadan alınan kemik doku kültüründe 48 saat sonra üreyen bakterinin kütle spektrofotometresi (VITEK MS, bioMerieux, Fransa) ile identifikasyonu sonucunda E. rhusiopathiae olduğu saptandı. Bir ay süre ile intramüsküler yoldan 3X1500 mg/gün ampisilin-sulbaktam tedavisi sonrası hastada iyileşme görüldü.

Anahtar Kelimeler

• Erysipelothrix rhusiopathiae,osteomiyelit,zoonoz,meslek hastalığı,yumuşak doku bozukluğu,osteomiyelit

Kaynakça

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