Acute hematogenous osteomyelitis in intravenous drug users.
The authors report a case of acute hematogenous osteomyelitis in a closed metatarsal fracture of an adult intravenous drug user. A transient Staphylococcus aureus bacteremia documented by blood cultures was sustained that presumably seeded the existing fracture. Osteomyelitis was documented by intraoperative cultures that matched the blood cultures and a Technetium-HMPAO-labeled leukocyte scan. Reliance on a noncompliant patient for information may have been a factor that resulted in significant morbidity in this case. Although the patient managed to do well after surgical intervention, osteomyelitis may have been avoidable. Treatment and a self-critical review of the approach to this patient population and decisions made in this case are also discussed.
Fox
I M
IM
UMDNI/Robert Wood Johnson Medical School, Camden, USA.
Brady
K
K
D000208:Acute Disease; D000328:Adult; D016470:Bacteremia / Q000209:etiology; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D008682:Metatarsal Bones / Q000293:injuries*; D010019:Osteomyelitis / Q000209:etiology*; D013203:Staphylococcal Infections / Q000209:etiology; D015819:Substance Abuse, Intravenous / Q000150:complications*