title: Acute osteomyelitis of the humerus mimicking malignancy: Streptococcus pneumoniae as exceptional pathogen in an immunocompetent adult.
abstract: BACKGROUND
  Chronic osteomyelitis due to direct bone trauma or vascular insufficiency is a frequent problem in orthopaedic surgery. In contrast, acute haematogenous osteomyelitis represents a rare entity that almost exclusively affects prepubescent children or immunodeficient adults.
  
  
  METHODS
  In this article, we report the case of acute pneumococcal osteomyelitis of the humerus in an immunocompetent and otherwise healthy 44-year-old male patient presenting with minor inflammation signs and misleading clinical features.
  
  
  CONCLUSIONS
  The diagnosis had to be confirmed by open biopsy which allowed the initiation of a targeted therapy. A case of pneumococcal osteomyelitis of a long bone, lacking predisposing factors or trauma, is unique in adults and has not been reported previously.
authors.affiliation: Clinic for Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Straße 22, D-81675, Munich, Germany. prodinger@ortho.med.tu-muenchen.de
authors.forename: Peter M
authors.initials: PM
authors.lastname: Prodinger
authors.forename: Hakan
authors.initials: H
authors.lastname: Pilge
authors.forename: Ingo J
authors.initials: IJ
authors.lastname: Banke
authors.forename: Dominik
authors.initials: D
authors.lastname: Bürklein
authors.forename: Reiner
authors.initials: R
authors.lastname: Gradinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Miethke
authors.forename: Boris M
authors.initials: BM
authors.lastname: Holzapfel
mesh_terms: D000208:Acute Disease; D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis*; D011008:Pneumococcal Infections / Q000175:diagnosis*; D011859:Radiography; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*