Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3542-3547
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3542
Disseminated osteomyelitis after urinary tract infection in immunocompetent adult: A case report
Young Jun Kim, Jae Hoon Lee
Young Jun Kim, Jae Hoon Lee, Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan 54538, South Korea
Author contributions: Kim YJ and Lee JH were the patient's physician, reviewed the literature, and contributed to manuscript drafting; Lee JH was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jae Hoon Lee, MD, PhD, Professor, Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, 460, Iksandaero, Iksan 54538, South Korea. john7026@wku.ac.kr
Received: May 27, 2020
Peer-review started: May 27, 2020
First decision: June 15, 2020
Revised: June 26, 2020
Accepted: August 6, 2020
Article in press: August 6, 2020
Published online: August 26, 2020
Processing time: 90 Days and 9.6 Hours
Abstract
BACKGROUND

Urinary tract infection (UTI) is one of the most common bacterial infections. Acute pyelonephritis or upper urinary tract infection is often accompanied by bacteremia; however, bacteremia resolves in most cases without complication. Rarely, complications due to bacteremia occur. One of these is osteomyelitis. It mainly affects the lumbar vertebral bodies, and rarely affects other site.

CASE SUMMARY

An 80-year-old woman presented to the hospital with a two-month history of pain in both legs. Two months ago, she was admitted to the hospital for fever, flank pain, and urinary frequency and was diagnosed with bacteremic UTI. During hospitalization, she complained of pain in both legs; however, the pain resolved shortly after, and no abnormalities were observed on physical examination. Therefore, she was placed on 2-wk antibiotic therapy for UTI without further evaluation for leg pain. However, pain recurred after discharge and persisted; therefore, an imaging test was performed. Bone scan and magnetic resonance imaging suggested osseous infection in both femurs, tibiae and patellae. Surgical treatment was performed, and tissue- and bone cultures revealed Escherichia coli, a previously observed pathogen, which demonstrated same antibiotic sensitivities, as noted in previous UTI. She was diagnosed with disseminated osteomyelitis, as a complication of UTI, and was placed on an 8-wk antibiotic therapy.

CONCLUSION

Indication for osteomyelitis should be high regardless of bone pain at sites other than lumbar spine after or during UTI.

Keywords: Urinary tract infection; Urosepsis; Complication; Disseminated; Osteomyelitis; Escherichia coli; Case report

Core tip: Osteomyelitis caused by urinary tract infections rarely occurs, and most cases involve the lumbar vertebral bodies. The involvement of sites other than the lumbar vertebrae has only been reported in a few cases. This study presents a rare case of disseminated osteomyelitis (involving bilateral femur, knee and tibia) caused by urinary tract infection (UTI) in an immunocompetent patient. Escherichia coli was isolated from both surgically excised tissue and bone cultures, and demonstrated same antibiotic sensitivities, as observed in the previous UTI. This case highlights that osteomyelitis after UTI can occur at sites other than the lumbar spine.