Postoperative Mycobacterium avium osteomyelitis confirmed by polymerase chain reaction.
An 18-year-old male with Escobar syndrome developed Mycobacterium avium osteomyelitis after corrective osteotomy. After three surgical interventions the infection reappeared a fourth time. Repeated attempts at microbiological diagnosis of the granulomatous lesions by microscopy and culture for conventional bacteria and Mycobacteria did not reveal any organism. The diagnosis of Mycobacterium avium finally was achieved by polymerase chain reaction. Extensive immunological work-up did not reveal signs of immunodeficiency. The patient was treated successfully by a combined surgical and chemotherapeutic approach consisting of clarithromycin, ethambutol and ciprofloxacin.


CONCLUSIONS
Polymerase chain reaction may be especially useful for clinical situations with a low bacterial load, especially for fastidious and slow growing pathogens like Mycobacteria. In our patient a combination of surgical therapy with a triple regimen containing clarithromycin proved successful for treatment of a localised infection with M. avium in a supposedly immunocompetent host.
Weigl
J A
JA
Paediatric Infectious Diseases, Children's Hospital Kiel, Germany.
Haas
W H
WH
D000015:Abnormalities, Multiple; D000293:Adolescent; D004200:Diseases in Twins; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis* / Q000628:therapy; D010019:Osteomyelitis / Q000382:microbiology* / Q000628:therapy; D010027:Osteotomy; D016133:Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000628:therapy; D013577:Syndrome