Citrobacter kosericausing osteomyelitis in a diabetic foot with concomitant acute gouty arthritis successfully treated with ertapenem

Abstract

We present an elderly diabetic man with left hallux pain and drainage who was initially diagnosed with acute gouty arthritis using the diagnostic rule for acute gout and monosodium urate crystals presented on synovial fluid analysis. Further investigation with surgical debridement, plain X-ray, MRI and wound culture revealed concomitant Citrobacter koseri septic arthritis with osteomyelitis. C. koseri is considered an opportunistic infection that rarely causes musculoskeletal infections. Acute gouty arthritis and septic arthritis are rarely seen occurring concomitantly in the same joint and are often difficult to differentiate due to similar findings on exam and imaging. The present case illustrates that osteomyelitis with an opportunistic organism can present concomitantly with acute gouty arthritis, and the diagnosis of one should not exclude the other.

Gut Microbiota Characterization in Patients with Asymptomatic Hyperuricemia: probiotics increased

“…In this study, the reduced bacteria in the AH population also had unidentified and unclassified bacteria with low abundance, such as unclassified_Enterobacteriaceae, unidentified_Enterobacteriaceae, unidentified_Lactobacillales, and unclassified_Enterococcaceae. Reports on the relationship between Enterobacteriaceae, Lactobacillales, and gout and other related diseases are similar to the results of this study [31]. The genus Enterococcaceae seems to be closely related to purine metabolism in existing studies, and this phenomenon is consistent with the results of this study.…”

Osteomyelitis Caused by Citrobacter koseri in a Young Immunocompetent Man

“…Citrobacter koseri is a non-sporulating, anaerobic, motile, gram-negative bacteria of the Enterobacteriaceae family [1]. It is part of the normal flora in mammalian gastrointestinal and urinary tracts and is considered an opportunistic infection [2]. C. koseri is well known for its involvement in pediatric central nervous system infections like neonatal brain abscesses and meningitis [3].…”