title: A rare case of acute osteomyelitis due to Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus in a young healthy adult.
abstract: BACKGROUND
  Most community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections affect skin or soft tissues, while invasive and life-threatening illnesses including osteomyelitis are less common. CA-MRSA infections occur especially in the pediatric age group, while the occurrence of CA-MRSA osteomyelitis in adults is uncommonly reported.
  
  
  METHODS
  A rare case of acute osteomyelitis of the femur caused by Panton-Valentine leukocidin (PVL)-positive CA-MRSA in a 37-year-old man in good health is presented. A pure bone biopsy revealed extensive inflammation, suggestive of acute osteomyelitis, with no evidence of neoplasm, and PVL-positive MRSA was isolated from the culture. Antibiotic treatment, with 6 weeks of intravenous vancomycin and 4 weeks of clindamycin, followed by 2 weeks of oral linezolid, was given, and 2 years after treatment completion, there has been no relapse of infection.
  
  
  CONCLUSIONS
  This case strongly suggests that we need to be aware of CA-MRSA osteomyelitis, which requires a high level of suspicion, prompt diagnosis, and appropriate antibiotic treatment.
authors.affiliation: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi, Hyogo 658-0017, Japan. Electronic address: westlife_take@yahoo.co.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takemori
authors.affiliation: Department of Orthopedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. Electronic address: osamunak@med.kagawa-u.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nakamura
authors.affiliation: Department of Orthopedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. Electronic address: yokkun@med.kagawa-u.ac.jp.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yamagami
authors.affiliation: Department of Orthopedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. Electronic address: nishimu@med.kagawa-u.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nishimura
authors.affiliation: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi, Hyogo 658-0017, Japan. Electronic address: trykwmt@med.kobe-u.ac.jp.
authors.forename: Teruya
authors.initials: T
authors.lastname: Kawamoto
authors.affiliation: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi, Hyogo 658-0017, Japan. Electronic address: akisue@med.kobe-u.ac.jp.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Akisue
authors.affiliation: Department of Orthopedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. Electronic address: sanutetu@med.kagawa-u.ac.jp.
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Yamamoto
keywords: Acute osteomyelitis; Adult; CA-MRSA; Case report; PVL-positive