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BMJ Case Reports 2018; doi:10.1136/bcr-2017-223782
  • Rare disease
  • CASE REPORT

Propionibacterium acnes and Staphylococcus epidermidis olecranon bursitis/osteomyelitis: a case involving surgical and antibiotic treatment

Open Access
  1. Marquam R Oliver3
  1. 1Utah Orthopaedic Specialists, Murray, Utah, USA
  2. 2Tufts University School of Medicine, Boston, Massachusetts, USA
  3. 3Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
  1. Correspondence to Dr John G Skedros, jskedrosmd{at}uosmd.com
  • Accepted 30 January 2018
  • Published 12 February 2018

Summary

This report describes a 63-year-old generally healthy male with septic olecranon bursitis caused by Propionibacterium acnes. The patient sustained a small laceration after striking the posterior aspect of his left elbow on a metal railing when he was at a public swimming pool. We concluded that P. acnes was not initially detected because cultures were only kept for 5 days. Consequently, initial antibiotic treatment failed. P. acnes and Staphylococcus epidermidis grew in a subsequent tissue culture. The infection did not respond to intravenous vancomycin although soft-tissue debridements were done. This likely reflected the presence of olecranon osteomyelitis (seen on MRI scans) in addition to inadequate treatment with this antibiotic in the setting of a polymicrobial infection. Eventually, the infection was eradicated with multiple soft-tissue debridements in addition to the continuation of vancomycin with daily intravenous piperacillin/tazobactam that was added for the final 4 weeks of antibiotic treatment.

Footnotes

  • Contributors All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval to the version to be published. All the authors were involved in the conception and design of the case report after seeing the patient throughout the course of his care. Each author assisted in the drafting and revision of the article and approved the final version. All authors also agree to be accountable for the article and will ensure that questions regarding the accuracy or integrity of the article are resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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