Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA.
Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.
BMC Infect Dis. 2024 Sep 27;24(1):1064. doi: 10.1186/s12879-024-09970-1.
A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.
一位 26 岁的男性，患有埃勒斯-当洛斯综合征、复发性外耳炎和慢性中耳炎，在亚利桑那州遭遇车祸后接受了左下肢截肢和开放性股骨骨折内固定术。尽管出院时已接受了两种未明抗生素治疗，但他仍因左腿剧痛和脓性分泌物而到我院急诊科就诊。评估发现有脓肿和股骨畸形愈合。最初的培养结果显示仅分离出少量拟杆菌属内生菌，导致使用达托霉素治疗。他的病情恶化，直到发现革兰阳性杆菌为戈登分枝杆菌，这是一种罕见的医院获得性分枝杆菌种。适当的抗生素治疗后病情显著改善。本病例强调了在患有骨科并发症的免疫功能低下患者中诊断和管理戈登分枝杆菌感染的挑战，并指出拟杆菌属内生菌是一种以前未报道的、可能为机会性病原体。
