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 ~  Abstract
 ~  Case Report
 ~  Discussion
 ~  Acknowledgments:
 ~  References

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CASE REPORT
Year : 2003  |  Volume : 21  |  Issue : 3  |  Page : 209-210
 

A case of chronic osteomyelitis due to arcanobacterium hemolyticum


Departments of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttaranchal - 248 140, India

Correspondence Address:
Departments of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttaranchal - 248 140, India

 ~ Abstract 

We report here a case of chronic osteomyelitis, which appeared to be tubercular, from the clinical, radiological and histopathological points of view. But on culture an unusual bacterium, Arcanobacterium hemolyticum, was isolated and the patient responded to treatment with clindamicin, prescribed in accordance to the sensitivity reports.

How to cite this article:
Biswas D, Gupta P, Gupta P, Prasad R, Arya M. A case of chronic osteomyelitis due to arcanobacterium hemolyticum. Indian J Med Microbiol 2003;21:209-10


How to cite this URL:
Biswas D, Gupta P, Gupta P, Prasad R, Arya M. A case of chronic osteomyelitis due to arcanobacterium hemolyticum. Indian J Med Microbiol [serial online] 2003 [cited 2019 Sep 22];21:209-10. Available from: http://www.ijmm.org/text.asp?2003/21/3/209/8021


Chronic Osteomyelitis, in our country, is mostly a sequel of inadequately treated acute osteomyelitis or is due to tuberculosis.[1] Ascertaining the correct etiology of the condition often becomes difficult and the patient is put on antitubercular treatment empirically. Here we report a case where culture studies revealed a rare bacterium, Arcanobacterium hemolyticum, in an apparent case of tubercular osteomyelitiis.

 ~ Case Report Top

A 45 year old male patient presented with seropurulent discharge from a sinus over the dorsum of his right foot, associated with local pain and swelling, for the last three years. There were repeated episodes of pain, swelling and discharge from the wound, which subsided temporarily with local treatment. On examination, there was diffuse swelling over the right foot with a secondary healed scar and a small sinus over the second metatarsal bone. The discharge was scanty, odourless, seropurulent and without any granule. Local temperature was normal with bony tenderness, but no bony thickening or irregularity was seen. Joint movements were normal.
X-ray of the right foot showed cortical thickening and irregularity of shaft of second metatarsus with a lytic area in the medulla and a small radiodense shadow in the center of the lytic area. Routine investigations were normal and the pus culture was sterile. Considering the provisional diagnosis of chronic osteomyelitis, the patient was subjected to saucerisation and curettage of the lytic area. Excised pieces of tissue were collected aseptically and sent for histopathology and culture.
On histopathological examination of the tissue, granulomatous reaction with the presence of occasional giant cells was found.
Overnight aerobic culture on 5% human blood agar yielded pure growth of tiny, smooth, circular and beta hemolytic colonies. On prolonged incubation for 48-72 hours, the colonies became bigger with a widened area of haemolysis. Gram staining of the colonies after overnight incubation revealed the presence of thin, straight to slightly curved, non-sporing, gram-positive bacilli with beaded appearance and occasional branching [Figure:1]. However, after 48 hours, the bacilli were fragmented, giving the appearance of gram positive cocci in chains. They were found to be non-acid fast and non-motile. Identification tests were done according to standard procedures and the bacterium was identified to be Arcanobacterium hemolyticum.[2],[3] The results of the identification tests are shown in the [Table - 1]. Antibiotic sensitivity testing on sheep blood agar showed that the isolate was sensitive to penicillin, ampicillin, amoxy-clav, cephalexin, cefotaxime, ceftazidime, cefuroxime, gentamicin, amikacin, erythromycin, clindamicin, vancomycin, ciprofloxacin, tetracycline but it was resistant to cotrimoxazole. Accordingly, the patient was put on clindamicin for four weeks and he recovered completely.

 ~ Discussion Top

A. hemolyticum, a coryneform bacilli, is likely to be encountered as a commensal of human skin or mucous membranes. Though rare, it has been reported from cases of cutaneous ulcers, cellulitis and non-healing wounds.[4],[5],[6],[7] Reports of involvement of the bacteria in osteomyelitis have, however, been very infrequent.
The causative role of the bacteria in the present case could be inferred because it was isolated in pure culture from operated pieces of tissue and hence the possibility of it being a skin contaminant was ruled out. Histopathological finding of granuloma with giant cell in such a case of chronic osteomyelitis may provoke a diagnosis of tuberculosis, but it was excluded in this case by performing culture-sensitivity. Moreover, the patient responded to non-tubercular antibiotic, prescribed in accordance to the culture-sensitivity report. The antimicrobial susceptibility pattern of the isolate was identical to what has been reported in an earlier study,[8] indicating that the bacteria, if identified properly, is quite amenable to eradication.

 ~ Acknowledgments: Top

The authors wish to thank Dr. Sanjoy Das, Department of Forensic Medicine and Toxicology, Himalayan Institute of Medical Sciences, Dehradun, for the photographic assistance. 

 ~ References Top

1.Ebnezer J. Textbook of Orthopedics: 2nd ed. (Jaypee Medical Publishers, Delhi) 2000.  Back to cited text no. 1    
2.Cowan and Steel. Manual for the identification of Medical Bacteria. 3rd ed. Barrow GI, Feltham RKA, Eds (Cambridge University Press, London) 1993;51-93.  Back to cited text no. 2    
3.Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC. Jr, Eds. Color Atlas and Textbook of Diagnostic Microbiology. 5th ed. (JB Lippincott Co., Philadelphia) 997;651-708.  Back to cited text no. 3    
4.Esteban J, Zapardiel J, Soriano F. Two cases of soft-tissue infection caused by Arcanobacterium haemolyticum. Clin Infect Dis 1994;18:835-836.  Back to cited text no. 4    
5.Ford JG, Yeatis RP, Givner LB. Orbital cellulitis, subperiosteal abscess, sinusitis, and septicaemia caused by Arcanobacterium haemolyticum. Am J Ophthalmol 1995;120:261-262.   Back to cited text no. 5    
6.Ritter E, Kaschner A, Becker C, Becker-Boost E, Wirsing von Konig CH, Finger H. Isolation of Arcanobacterium haemolyticum from an infected foot wound. Eur J Clin Microbiol Infect Dis 1993;12(6):473-474.   Back to cited text no. 6    
7.Bhat C, Hemashettar BM, Patil CS. Arcanobacterium haemolyticum in chronic wound infections. Indian J Med Microbiol 1997;15(1):41-42.  Back to cited text no. 7    
8.Carlson P, Kontiainen S, Renkonen OV. Antimicrobial susceptibility of Arcanobacterium haemolyticum. Antimicrob Agents Chemother 1994;38:142-143.  Back to cited text no. 8    
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2004 - Indian Journal of Medical Microbiology
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