Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.830
Peer-review started: April 17, 2020
First decision: April 24, 2020
Revised: May 1, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: February 6, 2021
Haematogenous osteomyelitis is an extremely rare disease occurring in adults, especially in developed countries. It is clearly a systemic infection, because bacteraemia spreads over proximal and distal long bones or paravertebral plexuses, resulting in acute or chronic bone infection and destruction.
A 46-year-old Caucasian male was complaining of a left thigh pain. It is known from the anamnesis that the patient developed severe pneumonia three months ago before the onset of these symptoms. The patient was diagnosed with haematogenous osteomyelitis, which developed a turbulent course and required complex combination therapy. The primary pathogen is thought to be Anaerococcus prevotii, which caused pneumonia before the onset of signs of osteomyelitis. Unfortunately, due to the complexity of identifying anaerobes and contributing nosocomial infections, the primary pathogen was not extracted immediately. After the manifestation of this disease, pathological fractures occurred in both femurs, as well as purulent processes in the lungs and molars accompanied. The patient received broad-spectrum antibiotic therapy and countless amounts of orthopaedic and reconstructive surgeries, but no positive effect was observed. The patient underwent osteosynthesis using an Ilizarov’s external fixation apparatus, re-fixations, external AO, debridements, intrame-dullary osteosynthesis with a silver-coated intramedullary nail, abscessotomies. The right femur healed completely after the pathological fracture and osteomyelitis did not recur. Left femur could not be saved due to non-healing, knee contracture and bone destruction. After almost three years of struggle, it was decided to amputate the left limb, after which the signs of osteomyelitis no longer appeared.
To sum it all up, complicated or chronic osteomyelitis requires surgery to remove the infected tissue and bone. Osteomyelitis surgery prevents the infection from spreading further or getting even worse up to such condition that amputation is the only option left.
Core Tip: Haematogenous osteomyelitis is an extremely rare disease in adults. Even rarer are pathological fractures that occur as a result. We present a clinical case in which a 46-year-old patient developed haematogenous osteomyelitis after pneumonia. Both femurs were damaged, but the right one was preserved thanks to the preventive built-in AO external fixation. The left thigh was amputated and the signs of osteomyelitis did not recur. The pathogen that caused this insidious disease, Anaerococcus prevotii, has not been reported in the literature as a cause of osteomyelitis. Moreover, there are no reported cases of osteomyelitis affecting both femurs at once.