title: Therapy-resistant septic olecranon bursitis due to Mycobacterium gordonae.
abstract: BACKGROUND
  Septic olecranon bursitis due to atypical mycobacteria is rare. An insidious beginning can delay diagnosis and treatment. Antibacterial therapy recommendations are not well-defined for bursitis caused by atypical mycobacteria. We present a rare case of olecranon bursitis caused by Mycobacterium gordonae, reporting our experiences regarding pathogen identification and antibiotic therapy, which differs from regimes used in common septic bursitis mostly caused by staphylococcus aureus.
  
  
  METHODS
  A 35-year-old male with bursitis olecrani received open bursectomy. Microbiological culture did not reveal bacteria. Due to wound healing complications revision surgery was performed four weeks postoperatively. Finally, Mycobacterium gordonae was identified by PCR and an antibiogram could be developed. A triple antimicrobial combination therapy with Rifampicin, Clarithromycin, and Ethambutol was administered systemically for 12 months. The patient was followed-up for 24 months.
  
  
  RESULTS
  After the second operation with pathogen identification and antibiotic combination therapy the wound healed without any additional complications. At last follow-up 24 months after the first surgery with bursectomy and 23 months after revision surgery with debridement, the patient was still pain free with no significant clinical findings or tenderness to touch at the operation site. Elbow range of motion was full.
  
  
  CONCLUSIONS
  As septic bursitis can be caused by many different and sometimes rare and difficult to identify bacteria, intraoperative probes should be taken and histopathological and microbiological analysis should be conducted, including PCR. In a young man with olecranon bursitis due to Mycobacterium gordonae surgical treatment and an antibiotic combination therapy showed a good clinical outcome after one and two years.
authors.affiliation: Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Konrads
authors.affiliation: Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany.
authors.forename: Kilian
authors.initials: K
authors.lastname: Rückl
authors.affiliation: Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany.
authors.forename: Mohammed
authors.initials: M
authors.lastname: El Tabbakh
authors.affiliation: Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Rudert
authors.affiliation: Institute of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kircher
authors.affiliation: Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany.
authors.forename: Piet
authors.initials: P
authors.lastname: Plumhoff