Tibial Osteomyelitis caused by Gordonia Bronchialis in an Imuunocompetent patient: a case report

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A 22 year old healthy, immunocompetent female with no past medical history underwent an arthroscopic knee surgery for a left anterior cruciate ligament and left lateral meniscal tears following a sport related injury. She had a reconstruction with hamstring auto graft from the same leg and a partial meniscectomy. 3 months after the surgery, she developed 2 areas of erythema, swelling, and pain around the harvest incision site with small abscess formation which was draining purulent discharge. She was afebrile with no systemic symptoms. At that time, she was seen at an urgent care facility and was prescribed bactrim for which she developed an allergic reaction a week after. Subsequently, she was seen at the orthopedic clinic for lack of improvement of her localized symptoms. She underwent incision and drainage of the abscess, and some bloody fluid was drained and sent for cultures. Meanwhile, she was started on Augmentin 825 mg po bid for 2 weeks. The culture grew branching gram-positive bacilli, which were sent out for further identification. Preliminary results reported possible nocardia species. However, later on, it turned out to be Gordonia bronchiali. She continued to have pain and drainage from 2 small openings just below the knee so it was decided to go for surgical debridement. The patient had an excisional debridement of the bone and hardware removal. She had an absorbable screw, which was in the tibial tunnel. The debridement was not done to the level of the knee joint. Tissue cultures again grew Gordonia bronchialis. The patient was put on Vancomycin empirically after the surgical debridement until the susceptibilities came back. The bacterium was sensitive to all tested antibiotics including amikacin, amoxicill... ... middle of paper ... ...ectious diseases". Clin Microbiol Rev 17 (4): 840–862.doi:10.1128/CMR.17.4.840-862.2004 16. Weisburg WG, Barns SM, Pelletier DA, Lane DJ (1991). "16S ribosomal DNA amplification for phylogenetic study" J Bacteriol 173 (2): 697–703. PMC 207061. PMID 1987160. 17. Brett P J, DeShazer D, Woods DE (1998). "Burkholderia thailandensis sp. nov., a Burkholderia pseudomallei-like species". Int J Syst Bacteriol 48: 317–320. doi:10.1099/00207713-48-1-317.PMID 9542103. 18. Schmidt TM, Relman DA (1994). "Phylogenetic identification of uncultured pathogens using ribosomal RNA sequences". Methods Enzymol. Methods in Enzymology 235: 205–22.doi:10.1016/0076-6879(94)35142-2. ISBN 9780121821364. PMID 7520119. 19. Gray JP, Herwig RP (1996). "Phylogenetic analysis of the bacterial communities in marine sediments". Appl Environ Microbiol 62 (11): 4049–59. PMC 168226. PMID 8899989.

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