A rare case of acute osteomyelitis due to Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus in a young healthy adult. (2017)

• Record Type: Journal Article
• Authors: Takemori, Toshiyuki; Nakamura, Osamu; Yamagami, Yoshiki; Nishimura, Hideki; Kawamoto, Teruya; Akisue, Toshihiro; Yamamoto, Tetsuji
• Is Part Of: International journal of surgery case reports. Volume 33(2017)
• Page Start: 4
• Page End: 7
• Publication Date: 2017
• Subjects: Acute osteomyelitis -- PVL-positive -- CA-MRSA -- Adult -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.02.021
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: The occurrence of CA-MRSA osteomyelitis in adults is uncommonly reported. CA-MRSA often produce Panton-Valentine leucocidin. CA-MRSA osteomyelitis involving the long bones has a propensity to mimic malignant bone tumors. Appropriate identification of the organism and detection of the presence of PVL will help to more rapidly provide adequate treatment and improve the prognosis. Abstract: Introduction: Most community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections affect skin or soft tissues, while invasive and life-threatening illnesses including osteomyelitis are less common. CA-MRSA infections occur especially in the pediatric age group, while the occurrence of CA-MRSA osteomyelitis in adults is uncommonly reported. Presentation of cases: A rare case of acute osteomyelitis of the femur caused by Panton-Valentine leukocidin (PVL)-positive CA-MRSA in a 37-year-old man in good health is presented. A pure bone biopsy revealed extensive inflammation, suggestive of acute osteomyelitis, with no evidence of neoplasm, and PVL-positive MRSA was isolated from the culture. Antibiotic treatment, with 6 weeks of intravenous vancomycin and 4 weeks of clindamycin, followed by 2 weeks of oral linezolid, was given, and 2 years after treatment completion, there has been no relapse of infection. Conclusion: This case strongly suggests that we need to be aware of CA-MRSA osteomyelitis, which requires a high level of suspicion, prompt diagnosis, and appropriate antibiotic treatment.