title: Recalcitrant chest wall Aspergillus fumigatus osteomyelitis after coronary artery bypass grafting: successful radical surgical and medical management.
abstract: This report describes a 62-year-old male diabetic patient with persistent chest wall osteomyelitis that developed after repeat coronary artery bypass grafting. The chronic infection was localized to the right anterior chest wall and refractory to medical and surgical treatment including long-term antiobiotics, five separate intraoperative debridements, and reconstruction with vascularized omentum over a two-year period at outside institutions. Aggressive surgical debridement with flap reconstruction resulted in definitive management. The organism isolated from multiple intraoperative bone, cartilage, and tissue cultures yielded Aspergillus fumigatus; therapy with itraconazole was utilized for 6 months. Surgical management of osteomyelitis and costochondritis is reviewed accompanied by a literature review on this uncommon cause of chronic chest wall infection.
authors.affiliation: Plastic Surgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
authors.forename: Mohammed M
authors.initials: MM
authors.lastname: Elahi
authors.forename: Amit
authors.initials: A
authors.lastname: Mitra
authors.forename: Julia
authors.initials: J
authors.lastname: Spears
authors.forename: James B
authors.initials: JB
authors.lastname: McClurken
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000601:surgery*; D001232:Aspergillus fumigatus; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D012074:Remission Induction; D035441:Thoracic Wall
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole