title: Septic osteomyelitis and polyarthritis with ureaplasma in hypogammaglobulinemia.
abstract: We describe a hypogammaglobulinemic woman with a one-year history of destructive septic osteomyelitis and polyarthritis with positive cultures for Ureaplasma urealyticum from joint exudate and blood. The clinical course was complicated by subcutaneous abscesses from which both U. urealyticum and Mycoplasma hominis were grown. Multiple routine cultures had been negative, except for sporadic findings of Staphylococcus 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.
authors.affiliation: Department of Infectious Diseases, Roslagstull Hospital, Karolinska Institute, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Jorup-Rönström
authors.forename: T
authors.initials: T
authors.lastname: Ahl
authors.forename: L
authors.initials: L
authors.lastname: Hammarström
authors.forename: C I
authors.initials: CI
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Rylander
authors.forename: H
authors.initials: H
authors.lastname: Hallander
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000150:complications*; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009180:Mycoplasmatales Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014509:Ureaplasma
chemical_list: D004318:Doxycycline