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Open Access Highly Accessed Case report

Acute osteomyelitis of the humerus mimicking malignancy: Streptococcus pneumoniae as exceptional pathogen in an immunocompetent adult

Peter M Prodinger1*, Hakan Pilge2, Ingo J Banke1, Dominik Bürklein3, Reiner Gradinger1, Thomas Miethke4 and Boris M Holzapfel3*

Author Affiliations

1 Clinic for Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Straße 22, D-81675, Munich, Germany

2 Department of Orthopaedics, University Clinic Duesseldorf, Moorenstr. 5, D-40225, Duesseldorf, Germany

3 Department of Orthopaedic Surgery, Koenig-Ludwig Haus, Julius-Maximilians-University of Wuerzburg, Brettreichstr. 11, D-97074, Wuerzburg, Germany

4 Institut für medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany

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BMC Infectious Diseases 2013, 13:266  doi:10.1186/1471-2334-13-266

Published: 5 June 2013

Abstract

Background

Chronic osteomyelitis due to direct bone trauma or vascular insufficiency is a frequent problem in orthopaedic surgery. In contrast, acute haematogenous osteomyelitis represents a rare entity that almost exclusively affects prepubescent children or immunodeficient adults.

Case Presentation

In this article, we report the case of acute pneumococcal osteomyelitis of the humerus in an immunocompetent and otherwise healthy 44-year-old male patient presenting with minor inflammation signs and misleading clinical features.

Conclusions

The diagnosis had to be confirmed by open biopsy which allowed the initiation of a targeted therapy. A case of pneumococcal osteomyelitis of a long bone, lacking predisposing factors or trauma, is unique in adults and has not been reported previously.

Keywords:
Acute osteomyelitis; Haematogenous; S. pneumoniae; Long bones; Immunodeficiency; Osteomyelitis of the humerus