Necrotizing osteomyelitis in a man with disseminated Mycobacterium chelonae infection

Abstract

Cases of disseminated nontuberculous mycobacterial (NTM) infection are difficult to treat. We encountered an elderly man with disseminated Mycobacterium chelonae infection. The clinical evaluation and treatment of patients with this type of systemic infection pose unique challenges. Disseminated NTM infection with bone involvement often requires surgical intervention in addition to antimicrobial therapy.

Differences in Clinical Characteristics and Treatments among Mycobacterial Osteomyelitis According to Species of Mycobacteria

“…Non-Tuberculous Mycobacterial (NTM) infections often do not stain AFB, unlike MTB (Korres et al, 2007). CT scans of bones of patients with disseminated NTM will demonstrate abnormal thickening of the affected cortical bone with sclerotic changes, encroachment of the medullary cavity and chronic draining of the sinus tracts (Harp et al, 2018). If a granuloma is observed, no microorganism is detected by culture, PCR for MTB is negative and there is a lack of response to initial treatments, NTM should be suspected (Talanow et al, 2013).…”

“…Unlike other cases of NTM osteomyelitis, a traumatic event did not typically precede presentation of the infection and the time of presentation varied case by case. In most of the cases, patients presented with red nodulo-pustular skin lesions at the site of infection (Talanow et al, 2013;Korres et al, 2007;Harp et al, 2018). Due to the prevalence of these skin lesions in M. Ch cases, it is suspected that the cause of the osteomyelitis is from disseminated cutaneous infection (Talanow et al, 2013).…”

“…In terms of diagnosis, various approaches were taken. These approaches include tissue cultures from the nodulo-pustular skin lesions (Korres et al, 2007;Harp et al, 2018) , punch biopsy of the skin lesions followed by Ziehl-Neelsen staining, PCR and DNA sequencing (Talanow et al, 2013) and fine-needle aspiration biopsy of the bone lesion (Korres et al, 2007;Pruitt et al, 1993). Visualization and localization of the bone lesions were best done by CT scan of the bone (Talanow et al, 2013;Pruitt et al, 1993).…”