Yu Zejun, Su Songchuan, Xiong Xiaotian, Huang Wenping, Tong Ting, Peng Zhenggang
Foot & Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, People's Republic of China.
Infect Drug Resist. 2025 Jul 7;18:3343-3350. doi: 10.2147/IDR.S525682. eCollection 2025.
Fungal osteomyelitis is rare in clinical practice, and osteomyelitis caused by Scedosporium apiospermum is even rarer, which is easy to misdiagnose, and it is resistant to many antifungal drugs, which makes it tricky to treat. Early diagnosis and accurate treatment are essential.
A 38-year-old healthy male has been experiencing recurrent pain in his right foot, accompanied by skin ulcers and exudate, for the past five years. He has been diagnosed with bacterial osteomyelitis at other hospitals as well as at our hospital. In the first stage, osteomyelitis lesion removal + vancomycin bone cement tamponade was used, and the infected bone tissue was taken for microbial culture and morphological observation, and identified as Scedosporium apiospermum. The patient was cured after postoperative treatment with voriconazole. No further signs of infection or Scedosporium apiospermum were detected during the second stage of bone reconstruction surgery, and the incision healed with grade A healing and no further signs of osteomyelitis, such as bone destruction, were detected after bone reconstruction surgery.
This is a rare case of Scedosporium apiospermum osteomyelitis of the right foot, which was successively misdiagnosed and finally cured by surgery and antifungal treatment with voriconazole. Given that Scedosporium apiospermum is extremely rare and resistant to antifungal drugs, this case highlights the importance of microbiologic culture and pathologic examination, surgical debridement, and precise antifungal treatment.
真菌性骨髓炎在临床实践中较为罕见，由尖端赛多孢菌引起的骨髓炎更为罕见，容易误诊，且对多种抗真菌药物耐药，治疗棘手。早期诊断和准确治疗至关重要。
一名38岁健康男性，在过去五年中右脚反复疼痛，伴有皮肤溃疡和渗出物。他在其他医院以及我院均被诊断为细菌性骨髓炎。第一阶段采用骨髓炎病灶清除+万古霉素骨水泥填塞，取感染骨组织进行微生物培养和形态学观察，鉴定为尖端赛多孢菌。患者术后使用伏立康唑治疗后痊愈。在第二阶段骨重建手术期间未检测到进一步的感染迹象或尖端赛多孢菌，切口甲级愈合，骨重建手术后未检测到骨髓炎的进一步迹象，如骨质破坏。
这是一例罕见的右脚尖端赛多孢菌骨髓炎病例，先后被误诊，最终通过手术及伏立康唑抗真菌治疗治愈。鉴于尖端赛多孢菌极为罕见且对抗真菌药物耐药，该病例突出了微生物培养和病理检查、手术清创以及精确抗真菌治疗的重要性。
