Mehmet EKİNCİ, Turgut AKGÜL, Necmettin TURGUT, Murat ALTAN, Mehmet CHODZA, Serkan BAYRAM, Ahmet SALDUZ

Uzun Kemik Osteomiyelitinin Nadir Bir Etkeni: Fusobacterium necrophorum

Osteomiyelite yol açan patojenler çeşitlilik göstermekle birlikte, bağışıklığı baskılanmış hastalarda daha nadir görülen mikroorganizmalar da etken olabilmektedir. Bu çalışmada nadir bir vaka olarak, Fusobacterium cinsi bir bakterinin sebep olduğu osteomiyelitten muzdarip bir hastanın tanı ve tedavisini sunmayı amaçladık. 48 yaşındaki kadın hasta sol uyluğunda üç aydır mevcut olan ağrı ve şişlik şikayetiyle bize başvurdu. Çekilmiş olan MR görüntülerine göre malign kemik tümörü ön tanısı alarak kliniğimize sevk edilmişti. Hastanın skleroderma nedeniyle immünosüpresif ilaç kullanma hikayesi mevcuttu. İlk başvurudan iki gün sonra patolojik femur kırığı geçiren hastaya osteomiyelitin cerrahi tedavisi olarak apse drenajı, debridman ve kırık için de antibiyotikli sement kaplı intramedüller çivi ile osteosentez ameliyatı yapıldı. Ameliyat öncesinde alınan örneklerin kültüründe Fusobacterium necrophorum üredi. Yatışı sırasında vakum yardımlı kapama ile takip edilen hasta, akut faz reaktanları normale döndükten ve IV antibiyotik tedavisi tamamlandıktan sonra taburcu edildi. İmmün sistemi baskılanmış hastalarda Fusobacterium cinsi bakterilerin osteomiyelit etkeni olabileceği ve kemikteki litik lezyonların ayırıcı tanısında osteomiyelit olasılığı akılda tutulmalıdır

An Uncommon Pathogen Causing Long Bone Osteomyelitis: Fusobacterium necrophorum

Although pathogens causing osteomyelitis vary, relatively uncommon microorganisms can cause osteomyelitis in immunosuppressed patients. In this study we aimed to present the diagnosis and treatment of a patient with a rare case of osteomyelitis due to infection with a species of Fusobacterium.A 48-year-old female patient complaining of swelling and pain in her left thigh for the last three months was referred to our clinic with a prediagnosis of bone malignancy based on the MRI findings. The patient had a history of immunosuppressive drug use for scleroderma. The patient suffered a pathological femoral fracture two days after her first visit to us. Abscess drainage and debridement were performed to treat her osteomyelitis, and an osteosynthesis including antibiotic cement-coated intramedullary nail insertion was performed for the fracture. Fusobacterium necrophorum grew in the culture of the preoperative specimens. The patient for whom vacuum-assisted closure was used during her hospitalization was discharged after the acute phase reactants returned to normal and the IV antibiotic treatment was completed.It should be noted that bacteria from the genus Fusobacterium can cause osteomyelitis in immunosuppressed patients, and that while making the differential diagnosis of the lytic lesions of bones osteomyelitis is one of the possibilities

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