Bilateral tibial chronic osteomyelitis due to Pantoea agglomerans in a patient with sickle cell disease
Service de Médecine Interne, 1Service de Radiologie, 2Service de Bactériologie, CHU Tenon (AP-HP) and 3Service d’Orthopédie, CHU Saint-Antoine (AP-HP), Paris, France
Correspondence to: C. Bachmeyer. E-mail: claude.bachmeyer{at}tnn.aphp.fr
A 20-yr-old Gabonese man with homozygous SS sickle cell disease and a mechanical aortic valve had leg pain, which was permanent for 2 months. He was healthy and afebrile. A 4-cm abscess was found at the anterior aspect of the left leg. X-ray showed periosteal reaction of upper part of both tibias. MRI showed the subcutaneous abscess of the left leg and replacement of marrow fat with fluid in both tibias (Fig. 1A and B). CT scan displayed cortical destruction of both tibias and the abscess extending into the centromedullary cavity. A fine needle aspirate from the collection of the left leg evacuated pus, with presence of Gram-negative bacilli, identified as Pantoea agglomerans on 16 S rDNA sequencing and producing CTX-M-15 extended-spectrum ß-lactamase. Blood cultures grew negative. No other site of infection was found. Treatment with imipenem and amikacine was given during 3 weeks, then imipenem and colimycine during 3 weeks, along with soft tissue and bone debridement of the left leg. The patient rejected any surgery of the right leg.
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Pantoea agglomerans is a Gram-negative bacterium belonging to the Enterobacteriaceae family. This organism is found in plants and in faeces of humans and animals and is rarely implicated in human infections, usually after plant injury or invasive procedures. Osteomyelitis of the hand, after a rose thorn has been reported in one case [1] and tibial osteitis after an open shaft fracture in another [2]. Our patient denied any local trauma that was probably unnoticed, but a haematogenous spread can not be ruled out.
The authors have declared no conflicts of interest.
References
- Vincent K, Szabo RM. Enterobacter agglomerans osteomyelitis of the hand from a rose thorn: a case report. Orthopedics (1988) 11:465–7.[Web of Science][Medline]
- Laporte C, Demachy MC, Thevenin-Lemoine C. Tibial osteitis caused by Pantoea agglomerans after open grade IIIB tibial shaft fracture. Rev Chir Orthop (2002) 88:625–7.[Medline]
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