Mycobacterium farcinogenes osteomyelitis of the proximal tibia: A case report

Abstract

Non-tuberculous mycobacteria (NTM) are an unusual cause of osteomyelitis. Mycobacterium farcinogenes is an uncommon cause of human disease. We describe here the first case of M. farcinogenes osteomyelitis in a 49-year-old man who underwent left knee anterior cruciate ligament and medial meniscal repair which was complicated by recurrent septic arthritis and surgical site infection. As a consequence, he underwent multiple surgical debridements. Ultimately, left proximal tibial osteomyelitis was diagnosed and M. farcinogenes was recovered from the tissue biopsy culture. Clinical improvement was achieved following surgical removal of the prosthesis along with prolonged combination antimicrobial therapy.

A Systematic Review of Nontuberculous Mycobacterium Infection Following Anterior Cruciate Ligament Reconstruction

“…1 , Table I). The reported NTM species were M. fortuitum 8 , 9 , M. farcinogenes 10 , and M. abscessus 11 - 13 (Table II). M. fortuitum and M. abscessus are rapidly growing species, and M. farcinogenes is slow-growing.…”

“…Al Farsi et al 10 reported on a 49-year-old diabetic male animal farm owner who developed an infection following ACL reconstruction. At 8 weeks postoperatively, the patient was diagnosed with septic arthritis and underwent multiple washout procedures and oral antibiotic treatment, without resolution of symptoms.…”

“…Furthermore, given the variable growth rate of NTM, all cultures should be held for a minimum of 2 weeks. Similarly, Al Farsi et al 10 reported that the primary culture required 7 days to positivity, and removal of prosthetic material played an integral role in achieving resolution. Ng and Yee Han 11 noted that a chronic draining sinus at the surgical site with negative cultures should raise suspicion for NTM infection.…”

“…Second, NTM are notoriously difficult to grow and identify in the laboratory. Positive identification of NTM occurred between 3 and 17 weeks after presentation for postoperative SSI 8 , [10][11][12][13] . In 5 of the 6 cases, the initial cultures (2 arthrocentesis and 3 surgical) failed to identify NTM.…”

Skin infection by Mycobacterium farcinogenes–senegalense group in an immunocompetent patient: a case report

“…Some following cases of osteomyelitis related to Mycobacterium farcinogenes were reported. [ 8 , 9 ]. We summarized the above-mentioned cases in Table 1 .…”