1 - Unidade de Infeciologia Pediátrica, Área de Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Serviço de Cirurgia Pediátrica, Área de Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
3 - Serviço de Ortopedia Pediátrica, Área de Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- 38th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID)
Background: Fusobacterium necrophorum is a common agent of disease in humans, but the occurrence of primary infections outside the head and neck area is extremely rare. Here, we report the case of septic arthritis, pyomyositis and fasciitis of the left tight in an otherwise healthy adolescent.
Case Presentation Summary: Previously healthy 15-year-old male presented with 12-hour history of fever and sudden severe pain in the left thigh and groin. Upper respiratory tract infection was referred the week before. Hip was flexed in external rotation with a limited range of motion and intense tenderness. Initial laboratory results revealed leukocytosis(19.580/μL) with 94%neutrophils and CRP of 281mg/L. MRI showed left coxofemoral 14mm e"usion with extensive psoas, proximal adductors and obturators pyomyositis, and multiple muscle abscesses. Started empirical antibiotics (ceftriaxone and clindamycin), and was submitted to arthrocentesis and arthrotomy. Due to worsening, with suspecting fasciitis, vancomycin was added, and underwent multiple interventions for abscess drainage and debridement. At day-20 Bacterial DNA-PCR was positive for Fusobacterium necrophorum, while synovial fluid grew oxacillin-susceptible Staphylococcus lugdunensis. Thorax-CT revealed bilateral ovular lesions with central cavitation. Tuberculosis was excluded. Echocardiography was normal, neck ultrasonography disclosed any thrombosis. Fever persisted for 50 days, and treatment was changed to meropenem. Left femur head avascular necrosis was diagnosed and underwent decompression surgery, followed by hyperbaric oxygen therapy. At 6 months follow-up, needs crutches for gait maintenance with limited hip mobility.
Learning Points/Discussion: Fusobacterium species are anaerobic, gram-negative bacilli that can cause metastatic osteoarticular infections. Coinfection with aerobic bacteria is a poor prognostic factor. Septic arthritis can be rapidly progressing and potentially fatal, requiring a high level of suspicion in patients with previous upper respiratory infections. In this case, despite intensive treatment with debridement, the patient progressed to avascular necrosis.
Palavras Chave: fasciitis; fusobacterium necrophorum; osteoarticular infections; pyomyositis; septic arthritis