Actinomycosis of the knee: a case report

Kundu, Zile Singh; Bhardwaj, Gaurav; Sangwan, SS; Arora, Bhavna

doi:10.1007/s10195-003-0025-2

Cited by 5 publications

(10 citation statements)

References 10 publications

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“…lungRt. Proximal tibiaAlcoholicssmokingActinomyces meyeriActinomycesSynovectomyPenicillin (IV) 8 W + penicillin (PO) 12 MCuredTekin et al [20]90/FKnee, ankle joint(proximal & distal tibia)UnknownUnknownActinomycesAmpicillin/sulbactam (IV) 2 W +Amoxicillin-clavulanate (PO) 6 MLower leg amputationKundu et al [6]50/MKnee joint(distal femur + proximal tibia)UnknownActinomycesActinomycesRepeated bone curettagePenicillin (IV) 6 WFailed- amputationNayak et.al. [17]30/MCalcaneusUnknownActinomycesMSSAActinomycesDebridement/Antibead insertionketaconazole + Tetracycline + Septran-DS (PO)6 WCuredYusof et al [7]34/MKnee joint, proximal tibiaUnknownNoneActinomycesBactrim and amoxycillin (PO) 6 MCured,But ROM limitationNandy et al [21]52/MTalus, medial malleolusNoneUnknownActinomycesClindamycin (IV) 3 WBelow knee amputationOur patient52/FDistal femurNoneNoneActinomycesRepeated bone curettagePenicillin (IV)8 W+ Amoxicillin-clavulanate (PO) 6 WCured…”

Section: Discussionmentioning

confidence: 99%

“…If there are atypical clinical findings or unexpected operative findings, we recommend culture, gram staining, Tb PCR, and pathologic examination. Early diagnosis and proper treatment for actinomycosis is important for a successful outcome and to prevent persistent draining sinus, deformation, sclerotic change of bone, and lower-limb amputation [6, 8, 17].…”

Section: Discussionmentioning

confidence: 99%

“…It shows variable clinical presentation and leads to diagnostic confusion, can mimic malignancy, and result in delayed therapy. In particular, in areas with a high prevalence of tuberculosis, initial treatment may fail due to misdiagnosis and therefore incorrect treatment of tuberculosis [1, 6–9]. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors.…”

Section: Introductionmentioning

confidence: 98%

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Actinomycotic osteomyelitis of a long bone in an immunocompetent adult: a case report and literature review

Ryu

Jeon

Kwon

et al. 2019

BMC Musculoskelet Disord

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Background Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors. Case presentation A woman aged 52 years with no history of trauma presented with severe pain, swelling, and increased local heat in the proximal area of the right knee 3 weeks after she first noticed discomfort. Magnetic resonance imaging showed persistent osteomyelitis of the distal metaphysis and diaphysis of the femur with a multifocal intraosseous abscess pocket. An incision and drainage of the abscess were conducted. The tissue culture, fungus culture, acid fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was successfully treated with intravenous penicillin G for 8 weeks followed by oral amoxicillin-clavulanate for 6 weeks with repeated surgical debridement and drainage. After a 5-year follow up, the patient had no signs of recurring infection or complications and she had full range of movement in the affected knee. Conclusions Although rare, actinomycotic osteomyelitis can occur in healthy people. Furthermore, actinomycotic osteomyelitis is easily misdiagnosed as tuberculosis in areas with a high prevalence of tuberculosis. To detect and identify the bacteria accurately, pathologic examination should be performed as well as culture tests, because the probability for culture confirmation of actinomycosis is quite low. The initial treatment is vital to a successful outcome without ostectomy or amputation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Actinomycotic osteomyelitis of a long bone in an immunocompetent adult: a case report and literature review

Ryu

Jeon

Kwon

et al. 2019

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…Initially it is 75% of the soft tissue of the disease, because of the trauma that is around 19%. In literature, cases involving finger, metacarpal and leg have been reported [4,9]. The majority of the cases reported have a clear history of trauma, either a human bite or a perforating injury with contamination from outside [4].…”

Section: Discussionmentioning

confidence: 99%

“…Radiographs are helpful to determine the extent of the infection, although they are not diagnostic. Radiological features of actinomycosis include both destruction and formation of bone, manifesting as multiple lytic lesion with sclerosis and periosteal reaction [4,5,9]. As the disease spreads to bone, the earliest changes include periosteal reaction with loss of cortical margins, often followed by erosion and adjacent sclerosis.…”

Section: Skeletal Actinomycosis Has Chronic Indolent Course and Presentsmentioning

confidence: 99%

Primary Actinomycosis of the Knee and Ankle Joint: An Unusual Manifestation

Tekin¹,

Gem²,

Karakaya³

2012

J Bacteriol Parasitol

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Actinomycosis caused by Actinomyces spp. is a chronic, progressive, suppurative and granulomatous bacterial infection. The general sites of infection are the head and neck, thorax and abdomen. Primary actinomycosis infection both on the knee and the ankle is uncommon. We report a very rare case of actinomycosis of the knee and ankle joint that was diagnosed and successfully treated with surgical resection and long-term antibiotic therapy. Figure 1: Left knee with ankle joint showing a swelling and multiple discharging sinuses.

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