title: [Streptococcus milleri: An unusual cause of skull extensive osteomyelitis in an immunocompetent patient].
abstract: BACKGROUND
  Streptococcus milleri (Streptococcus anginosus, intermedius and constellatus) are commensal organisms, which can become pathogenic and cause infection with frequent abscess formation, local or metastatic extension. Osteomyelitis of the skull has been rarely reported in this type of infection.
  
  
  METHODS
  Skull osteomyelitis due to Streptococcus milleri is reported in a 61-year-old immunocompetent man without any medical history, occurring 10 months after a head injury without any wound or complication at initial presentation. A progressive right parieto-occipital headache with worsening and increased acute phase reactants evoked a giant cell arteritis. After few days of corticosteroid therapy (0.5 mg/kg/day), diagnosis of subcutaneous abscess associated to an extensive osteomyelitis of the skull due to Streptococcus milleri was diagnosed. The outcome was favorable after drainage of one liter of pus, irrigation, debridement and antibiotherapy by amoxicillin for 8 weeks.
  
  
  CONCLUSIONS
  It is necessary to discuss the differential diagnosis of giant cell arteritis particularly when symptoms are unusual. Even a short-term corticosteroid therapy may dramatically exacerbate an undetected infection.
authors.affiliation: Service de rhumatologie, centre hospitalier universitaire, 2, avenue Foch, 29609 Brest cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Duquenne
authors.affiliation: Service de rhumatologie, centre hospitalier, 194, avenue Rubillard, 72037 Le Mans cedex 9, France.
authors.forename: E
authors.initials: E
authors.lastname: Dernis
authors.affiliation: Service de radiologie, centre hospitalier, route de Fontevraud, BP 100, 49403 Saumur cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Zehrouni
authors.affiliation: Service d'oto-rhino-laryngologie, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Bizon
authors.affiliation: Service de diabétologie-endocrinologie, centre hospitalier, 194, avenue Rubillard, 72037 le Mans cedex 9, France. Electronic address: mduquenne@ch-lemans.fr.
authors.forename: M
authors.initials: M
authors.lastname: Duquenne
mesh_terms: D000038:Abscess / Q000150:complications / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology; D012886:Skull / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D034364:Streptococcus milleri Group / Q000302:isolation & purification
keywords: Crâne; Immunocompetent; Immunocompétent; Osteomyelitis; Ostéite; Skull; Streptococcus milleri