Postoperative Mycobacterium avium osteomyelitis confirmed by polymerase chain reaction

• Published in: European journal of pediatrics Vol. 159; no. 1-2; pp. 64 - 69
• Main Authors: WEIGL, J. A. I, HAAS, W. H
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 2000; Berlin Springer Nature B.V
• Subjects: Abnormalities, Multiple; Adolescent; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Ciprofloxacin; Clarithromycin; Diagnosis; Diseases in Twins; Ethambutol; Human bacterial diseases; Humans; Immunocompetence; Immunodeficiency; Infectious diseases; Magnetic Resonance Imaging; Male; Medical sciences; Mycobacterium avium; Mycobacterium avium-intracellulare Infection - diagnosis; Mycobacterium avium-intracellulare Infection - therapy; Osteomyelitis; Osteomyelitis - microbiology; Osteomyelitis - therapy; Osteotomy; Patients; Polymerase chain reaction; Polymerase Chain Reaction - methods; Sensitivity and Specificity; Surgical Wound Infection - microbiology; Surgical Wound Infection - therapy; Syndrome; Human; Iatrogenic; Osteotomy; Diseases of the osteoarticular system; Mycobacterium avium; Male; Bone disease; Bacteriological investigation; Case study; Polymerase chain reaction; Microbiological investigation; Mycobacteriales; Surgery; Osteitis; Adolescent; Mycobacteriaceae; Bacteria; Complication; Actinomycetes; Diagnosis; Molecular biology
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/PL00013806

An 18-year-old male with Escobar syndrome developed Mycobacterium avium osteomyelitis after corrective osteotomy. After three surgical interventions the infection reappeared a fourth time. Repeated attempts at microbiological diagnosis of the granulomatous lesions by microscopy and culture for conventional bacteria and Mycobacteria did not reveal any organism. The diagnosis of Mycobacterium avium finally was achieved by polymerase chain reaction. Extensive immunological work-up did not reveal signs of immunodeficiency. The patient was treated successfully by a combined surgical and chemotherapeutic approach consisting of clarithromycin, ethambutol and ciprofloxacin.
Polymerase chain reaction may be especially useful for clinical situations with a low bacterial load, especially for fastidious and slow growing pathogens like Mycobacteria. In our patient a combination of surgical therapy with a triple regimen containing clarithromycin proved successful for treatment of a localised infection with M. avium in a supposedly immunocompetent host.