Summary
We describe a hypogammaglobulinemic woman with a one-year history of destructive septic osteomyelitis and polyarthritis with positive cultures forUreaplasma urealyticum from joint exudate and blood. The clinical course was complicated by subcutaneous abscesses from which bothU. urealyticum andMycoplasma hominis were grown. Multiple routine cultures had been negative, except for sporadic findings ofStaphylococcus epidermidis before specific cultures for mycoplasmas were performed. Therapy with beta-lactam antibiotics, clindamycin, rifampicin, fusidic acid and aminoglycosides had been given without obvious clinical effect. Intravenous doxycycline treatment instituted after microbiological diagnosis had a dramatic effect on the clinical course. The clinical suspicion of mycoplasma and ureaplasma as etiologic agents of orthopaedic infections in hypogammaglobulinemic patients is mandatory in order to perform appropriate cultures.
Zusammenfassung
Wir beschreiben den Fall einer destruktiven Osteomyelitis und Polyarthritis bei einer Frau mit Hypogammaglobulinämie; aus Gelenkexsudat und Blut wurdeUreaplasma urealyticum isoliert; der Krankheitsverlauf zog sich über ein Jahr hin. Als Komplikation traten subkutane Abszesse auf, aus denenU. urealyticum undMycoplasma hominis gezüchtet wurden. Routinekulturen waren wiederholt negativ; bevor spezifische Kulturen für Mykoplasmen angelegt wurden, fand sich sporadischStaphylococcus epidermidis. Therapieversuche mit Betalactam-Antibiotika, Clindamycin, Rifampicin, Fusidinsäure und Aminoglykosiden waren ohne eindeutige klinische Wirkung. Der klinische Verlauf nahm eine dramatische Wende, als nach mikrobiologischer Erregerdiagnostik eine intravenöse Therapie mit Doxycyclin eingeleitet worden war. Bei Knochen- und Gelenkinfektionen, die bei Patienten mit Hypogammaglobulinämie auftreten, muß der Kliniker an eine Mykoplasma- und Ureaplasma-Ätiologie denken, um die entsprechenden kulturellen Untersuchungen zu veranlassen.
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Jorup-Rönström, C., Ahl, T., Hammarström, L. et al. Septic osteomyelitis and polyarthritis with ureaplasma in hypogammaglobulinemia. Infection 17, 301–303 (1989). https://doi.org/10.1007/BF01650712
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DOI: https://doi.org/10.1007/BF01650712