Chronic Osteomyelitis Due to Tissierella carlieri: First Case

A 54-year-old woman sustained an open fracture of the right femoral shaft after a bicycle accident in 1985. Several operations were performed, the last including internal fixation using a plate and screws. In 2002, acute diverticulitis was treated with ciprofloxacin/metronidazole. In 2007, she presented with pain and swelling of the right thigh. Plain radiographs showed radiolucent femoral areas (Figure ​(Figure1a1a and b). Treatment was with debridement and removal of orthopedic hardware except for a difficult-to-remove screw fragment. Gentamicin beads were temporarily placed along the femur. Eight intraoperative specimens showed no growth after 10 days. Because of poor wound healing, a computed tomography scan was obtained, showing a sinus tract, femoral cortical defects, and intramedullary air (Figure ​(Figure1c–e).1c–e). Additional debridement was done; cultures of intraoperative biopsy specimens again remained sterile. Amoxicillin/clavulanate was prescribed for 2 weeks, and ciprofloxacin/rifampin was prescribed for 10 weeks.