title: Osteomyelitis of a long bone due to Fusobacterium nucleatum and Actinomyces meyeri in an immunocompetent adult: a case report and literature review.
abstract: BACKGROUND
  Fusobacterium species are uncommon causes of osteomyelitis. These organisms are normal flora of the oral cavity. Therefore, they mostly cause osteomyelitis of the head and neck. Hematogenous osteomyelitis at distant sites other than the head and neck has rarely been reported in pediatric or immunocompromised patients. Here, we report the first case of osteomyelitis of a long bone combined with a muscle abscess due to Fusobacterium nucleatum in an otherwise healthy adult.
  
  
  METHODS
  A 59-year-old Korean man was admitted for pain and swelling of the right lower leg, which had been persistent for two weeks. Magnetic resonance imaging showed osteomyelitis of the right fibula with a surrounding muscle abscess of the right lower leg. Incision and drainage was performed, and repetitive tissue cultures grew F. nucleatum. In this patient, it was presumed that recurrent periodontitis caused hematogenous seeding of F. nucleatum to a distant site leading to osteomyelitis with a muscle abscess. The patient was successfully treated with intravenous ampicillin-sulbactam for three weeks and oral amoxicillin-clavulanate for eight weeks. He also underwent repeated surgical drainage. He has no evidence of recurrence after seven months of follow-up.
  
  
  CONCLUSIONS
  Clinicians should be aware that F. nucleatum could be the etiologic agent of hematogenous osteomyelitis of a long bone in an immunocompetent patient.
authors: Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Min Ji
authors: MJ
authors: Lee
authors: Young Eun
authors: YE
authors: Ha
authors: Hye Yon
authors: HY
authors: Park
authors: Jun Hee
authors: JH
authors: Lee
authors: Yoon Jung
authors: YJ
authors: Lee
authors: Ki Sun
authors: KS
authors: Sung
authors: Cheol-In
authors: CI
authors: Kang
authors: Doo Ryeon
authors: DR
authors: Chung
authors: Jae-Hoon
authors: JH
authors: Song
authors: Kyong Ran
authors: KR
authors: Peck
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D000190:Actinomyces / Q000302:isolation & purification; D000196:Actinomycosis / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D060085:Coinfection / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D004322:Drainage; D005360:Fibula / Q000473:pathology; D005674:Fusobacterium Infections / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D016967:Fusobacterium nucleatum / Q000302:isolation & purification; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents