Takemori Toshiyuki, Nakamura Osamu, Yamagami Yoshiki, Nishimura Hideki, Kawamoto Teruya, Akisue Toshihiro, Yamamoto Tetsuji
Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi, Hyogo 658-0017, Japan.
Department of Orthopedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
Int J Surg Case Rep. 2017;33:4-7. doi: 10.1016/j.ijscr.2017.02.021. Epub 2017 Feb 17.
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.
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.
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.
大多数社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染累及皮肤或软组织，而包括骨髓炎在内的侵袭性和危及生命的疾病则较少见。CA-MRSA感染尤其发生在儿童年龄组，而成人CA-MRSA骨髓炎的发生报道较少。
本文介绍了一例罕见的由杀白细胞素（PVL）阳性的CA-MRSA引起的37岁健康男性急性股骨骨髓炎病例。单纯骨活检显示广泛炎症，提示急性骨髓炎，无肿瘤证据，培养分离出PVL阳性的MRSA。给予静脉注射万古霉素6周、克林霉素4周，随后口服利奈唑胺2周的抗生素治疗，治疗完成2年后，感染无复发。
该病例强烈提示我们需要警惕CA-MRSA骨髓炎，这需要高度怀疑、及时诊断和适当的抗生素治疗。
