Osteomyelitis pubis caused by Kingella kingaein an adult patient: Report of the first case

Abstract

BackgroundKingella kingae is the second most common pathogen causing paediatric arthritis and is described to be the causative bacteria in some paediatric osteomyelitis. Its microbiological detection is particularly difficult due to its slow growing. To our best knowledge this is the first case description of osteomyelitis pubis caused by this microorganism.Case presentationWe report the unusual case of pubic osteomyelitis with soft tissue abcess caused by Kingella kingae in an adult patient of 66 years with a history of end-stage renal disease and breast carcinoma. Diagnosis was based on imaging and the microorganism was isolated from Computed Tomography-guided aspiration of synovial fluid. The infection resolved completely after twelve weeks of treatment with oral amoxicillin.ConclusionThis case description highlights the importance in osteoarticular infections of systematic inoculation of synovial liquid in BACTEC vials to optimise the detection of causative organisms, which can necessitate specific treatments.

Kingella kingae: Carriage, Transmission, and Disease

“…Kingella kingae affects the tubular tibia, femur, humerus, radius, or ulnar bone in more than half of the cases (102,(185)(186)(187)(188)(189)(190)(191)(192), yet involvement of the pelvis (193,194), calcaneus (102,(195)(196)(197), talus (172,198,199), sternum (16,130,200), or clavicle (201) is also common (18,102,153,172). Epiphysial invasion, which rarely occurs in osteomyelitis of other etiology, is frequently observed in K. kingae infections (152,164,188,202,203).…”

Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

“…If the disease is progressive in spite of specific antibiotic therapy, surgical debridement with curettage and jet lavage is indicated. Invasive surgical procedures seem not to be necessary in most cases, due to the often spectacular response to simple antibiotherapy in arthritis and in discitis [ 6 ]. We recommend starting antibiotic immediately after culture is obtained for microbiology.…”

Kingella kingaeCausing Septic Arthritis of the Knee in anImmunocompetentAdult

“…In contrast, presentation in later life occurs almost exclusively in those with significant other predisposing factors. Examples frequently causing immunosuppression include haematological malignancies, acquired immunodeficiency syndrome, systemic lupus erythematosus, diabetes mellitus, rheumatoid arthritis, tumours, and end stage renal disease [ 10 ]. Infection involving the bone or joint is rare, more classically causing endocarditis, spondylodiscitis, or bacteraemia [ 10 ].…”