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Case report
AIDS presenting as radial bone tuberculosis and pyogenic methicillin-sensitive Staphylococcus aureus osteomyelitis
  1. Nigel Jeronimo Cortez Santos1,
  2. Isabelle Dominique Villegas Tomacruz1,
  3. Frances Lina Lantion-Ang2 and
  4. Paula Veronica San Juan Reyes3
  1. 1Department of Medicine, University of the Philippines Manila, Manila, Philippines
  2. 2Division of Endocrinology, Diabetes and Metabolism Department of Medicine, Philippine General Hospital University of the Philippines Manila, Manila, Philippines
  3. 3Department of Orthopedics, Philippine General Hospital, Manila, Philippines
  1. Correspondence to Dr Nigel Jeronimo Cortez Santos; nigel.jeronimo.santos{at}gmail.com

Abstract

Osteomyelitis is a rare initial presentation of HIV. We report a case of a 25-year-old, apparently well man presenting with a traumatic, pathological fracture of the right radius. He had a 2-week history of low-grade fever, swelling and purulent discharge of the radial aspect of his right forearm. Osteomyelitis, secondary bacteraemia and pneumonia were clues that led physicians to test for HIV. Multiple debridement, sequestrectomy and vacuum-assisted closure were done. Tissue cultures revealed Mycobacterium tuberculosis (TB) and methicillin-sensitive Staphylococcus aureus. He was treated successfully with 6 weeks of culture-guided intravenous oxacillin, staphylococcal decontamination and first-line anti-TB regimen (rifampicin, isoniazid, ethambutol, pyrazinamide). Antiretroviral agents were started thereafter. Successful infection control and preservation of limb functionality was achieved with a multidisciplinary team approach. To our knowledge this is the first reported case of an adult patient with HIV presenting with tuberculous and pyogenic osteomyelitis of the radial bone.

  • musculoskeletal and joint disorders
  • bone and joint infections
  • HIV / AIDS
  • orthopaedic and trauma surgery
  • TB and other respiratory infections
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Footnotes

  • Twitter @nigelsantosmd, @DTomacruzMD

  • Contributors NJCS was the primary author and attending physician of this case. IDVT was the secondary author and was also an attending physician of this case. She contributed to the pathophysiology and review of related literature. FLL-A was our case consultant, coauthor, final editor and senior attending physician of this case. PVSJR was the orthopaedic surgeon and coauthored the orthopaedic surgical aspects of this case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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