Uzun Kemik Osteomiyelitinin Nadir Bir Etkeni: Fusobacterium necrophorum / An Uncommon Pathogen Causing Long Bone Osteomyelitis: Fusobacterium necrophorum

Osteomiyelite yol acan patojenler cesitlilik gostermekle birlikte, bagisikligi baskilanmis hastalarda daha nadir gorulen mikroorganizmalar da etken olabilmektedir. Bu calismada nadir bir vaka olarak, Fusobacterium cinsi bir bakterinin sebep oldugu osteomiyelitten muzdarip bir hastanin tani ve tedavisini sunmayi amacladik. 48 yasindaki kadin hasta sol uylugunda uc aydir mevcut olan agri ve sislik sikayetiyle bize basvurdu. Cekilmis olan MR goruntulerine gore malign kemik tumoru on tanisi alarak klinigimize sevk edilmisti. Hastanin skleroderma nedeniyle immunosupresif ilac kullanma hikayesi mevcuttu. Ilk basvurudan iki gun sonra patolojik femur kirigi geciren hastaya osteomiyelitin cerrahi tedavisi olarak apse drenaji, debridman ve kirik icin de antibiyotikli sement kapli intrameduller civi ile osteosentez ameliyati yapildi. Ameliyat oncesinde alinan orneklerin kulturunde Fusobacterium necrophorum uredi. Yatisi sirasinda vakum yardimli kapama ile takip edilen hasta, akut faz reaktanlari normale dondukten ve IV antibiyotik tedavisi tamamlandiktan sonra taburcu edildi. Immun sistemi baskilanmis hastalarda Fusobacterium cinsi bakterilerin osteomiyelit etkeni olabilecegi ve kemikteki litik lezyonlarin ayirici tanisinda osteomiyelit olasiligi akilda tutulmalidir. Anahtar Kelimeler: Fusobacterium necrophorum; osteomiyelit; sement kapli civi Abstract Although pathogens causing osteomyelitis vary, relatively uncommon microorganisms can cause osteomyelitis in immunosuppressed patients. In this study we aimed to present the diagnosis and treatment of a patient with a rare case of osteomyelitis due to infection with a species of Fusobacterium. A 48-year-old female patient complaining of swelling and pain in her left thigh for the last three months was referred to our clinic with a prediagnosis of bone malignancy based on the MRI findings. The patient had a history of immunosuppressive drug use for scleroderma. The patient suffered a pathological femoral fracture two days after her first visit to us. Abscess drainage and debridement were performed to treat her osteomyelitis, and an osteosynthesis including antibiotic cement-coated intramedullary nail insertion was performed for the fracture. Fusobacterium necrophorum grew in the culture of the preoperative specimens. The patient for whom vacuum-assisted closure was used during her hospitalization was discharged after the acute phase reactants returned to normal and the IV antibiotic treatment was completed. It should be noted that bacteria from the genus Fusobacterium can cause osteomyelitis in immunosuppressed patients, and that while making the differential diagnosis of the lytic lesions of bones osteomyelitis is one of the possibilities. Key Words: Fusobacterium necrophorum; osteomyelitis; cement-coated nail