Chronic anaerobic osteomyelitis of the foot / Paul C. Lucas.

Includes appendices and bibliographical references.

ABSTRACT: Osteomyelitis is a difficult to treat infection, which can only occur after a very large inocula, trauma or the presence of foreign bodies, which require long term therapy. It is usually caused by Staphylococcus aureus, a gram positive cocci and caused by other organisms such as Actinomyces. We are presenting a 34 year old male, who initially presented with soft tissue mass at the right after a trauma, with no other signs and symptoms noted such as fever. Physical examination then was unremarkable. The patient underwent excision biopsy of the mass at the right foot and microsections of which showed fibrocollagenous and fibroadipose tissue with large, basophilic staining bacterial colonies surrounded by liquefaction necrosis, in which it has numerous inflammatory cells, comprised predominantly with neutrophils admixed with lymphocytes. The finding then was consistent with actinomycosis. The patient was initially given Prostaphlin 500 mg/cap, QID for 7 days as home medication. The patient was recurrently admitted due to non-healing lesion at the right foot where he was given repeatedly with parenteral and oral antibiotic therapy, which offered temporary resolution of the lesion. An x-ray of the right foot was done revealing osteomyelitis. Another biopsy of the affected area showed acute and chronic non-specific inflammation with abscess and osteomyelitis. Penicillin was continued and ESR monitoring was done. The patient then remain asymptomatic. There are reported cases of osteomyelitis caused by actinomycosis in different sites treated by long term antibiotics therapy. This case is a reportable case in the Philippines and long term antibiotic therapy together with patients awareness of the clinical outcome of the disease contribute to better prognosis.

Research - Department of Medicine