Case Report on Mucormycotic Osteomyelitis of Maxilla

Introduction: The upper jaw is formed by the maxilla, one of the basic bones of the face. It is a crucial viscerocranium structure that aids in the creation of the palate, nose, and orbit. The upper teeth are held in place by the alveolar process of the maxilla, which is vital for mastication and speaking. Because of its substantial vascular supply, maxillary necrosis is uncommon compared to mandible necrosis [1]. Maxillary necrosis can be caused by bacterial infections like osteomyelitis, viral infections like herpes zoster, or fungal infections like mucormycosis, as well as trauma, radiation, and other factors [2]. Long-term use of antibiotics or corticosteroids, on the other hand, may result in an opportunistic infection. Mucormycosis is a fungal infection that mostly affects immunocompromised persons. These fungi are widespread in many people, although the symptoms have been linked to a weakened immune system. Mucormycosis is a life-threatening illness that frequently affects immunocompromised individuals due to diabetic ketoacidosis, neutropenia, organ transplantation, and elevated blood iron levels. Clinical Findings: The patient have a complaint of discomfort in the upper left side of the jaw was rapid in start, dull hurting, intermittent in character, and worse on mastication. A radiating headache on the left side is also a complaint. Diagnostic Evaluation: CRP - 12.48 m/ L, Calcium 8.1 mg/dl, KFT-Ser (urea – 29 mg/dl, Creatinine 0.4 mg/dl, Sodium 138 mmol/L, Potassium -4.3 mmol/L, Albumin 2.6 g/dl,) Urine exam routine Pus cells 1-2 cells, urine albumin nil, Crystal 3-4 calcium oxalate Crystal, 2D echo was done on dated 31/5/21, MRI was done, Cardiac call was done. Therapeutic Intervention: If not recognised and treated early, fungal osteomyelitis is more invasive than bacterial osteomyelitis. Treatment is given to the patient as a follow-up. Debridement of necrotic tissue on a local level. Antibiotics - Tab Augmentine 625 mg, Tab paracetamols 500 mg, Inj T. T 0.5 ml in a single dosage, Antifungal treatment, and Betadine gargle twice a day. Conclusion: On 04/06/2021, a 58-year-old male was hospitalised to AVBR Hospital's Oral Surgery Ward 35 after being diagnosed with Mucormycotic Osteomyelitis of the Maxilla. The patient is being counselled on how to proceed with his treatment.

Mandibular Florid Cemento-Osseous Dysplasia: A Case Report

Background: Florid cemento-osseous dysplasia (FCOD) is a non-neoplastic lesion involving multiple quadrants of the jaw. Case presentation: Patients are usually asymptomatic, and the diagnosis mainly depends on radiographic and clinical examinations. Here, we describe a 50-year-old female patient with clinical manifestations of bone defect, no pain or swelling, combined with imaging indicators of secondary infection. However, there are no accepted treatment guidelines for complex FCOD. Conclusions: Therefore, based on a review of the literature, this article describes treatment approaches for symptomatic patients and details the successful treatment of FCOD with superimposed fungal osteomyelitis.

Candida Albicans Osteomyelitis after Chest Wall Blunt Trauma: A Case Report

Fungal osteomyelitis is a rare disease that can occur in immunocompromised patients. We report a case of a patient with a primary rib osteomyelitis after a blunt trauma of the chest wall. Aggressive surgical debridement along with antifungal therapy was the cornerstone of the disease management in this patient.

Bone sporotrichosis: 41 cases from a reference hospital in Rio de Janeiro, Brazil

Background Bone sporotrichosis is rare. The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis and the bone presentations are increasing. Methods We studied a retrospective cohort of 41 cases of bone sporotrichosis, diagnosed from 1999–2016. The inclusion criteria was fungal culture isolation from any clinical specimen associated to bone involvement (radiography and/or computed tomography) compatible with fungal osteomyelitis or histopathological findings of bone material compatible with sporotrichosis. Molecular identification was performed when possible. Results Male patients represented 58.5% of the cases, with a cohort median age of 43 years. Immunosuppressive conditions were present in 68.3% of the patients, mostly HIV coinfection (51.2%). Multifocal bone involvement (more than one anatomical segment) was diagnosed in 61% of the patients, while 39% presented unifocal involvement. The bones of the hands were the most affected (58.5%), followed by the feet (41.5%) and tibia (26.8%). Multifocal group was characterized by a higher proportion of males (p = 0.0045) with immunosuppressive conditions (p = 0.0014). Amphotericin B followed by oral itraconazole was the main treatment, with a median time of 16.7 months (1.5 to 99.2 months), and cure of 53.7% of the patients (84.6% of immunocompetent and 39.3% of immunocompromised patients). Sequelae occurred in 12.2% of the patients—amputations (7.3%) and ankylosis (4.9%), while 22% died in the course of the disease. Sporothrix brasiliensis was the causative agent in all the 9 (22%) performed cases. Conclusions Bone sporotrichosis is a chronic, challenging condition with prolonged treatment, often with poor results and sequelae.

Sternectomy for Candida albicans sternal osteomyelitis after left ventricular assist device implantation

Fungal osteomyelitis is an uncommon complication after cardiac surgery and associated with high mortality. A case of Candida albicans and Staphylococcus epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a 60-year-old male patient is presented here. After clinical identification and confirmation with microbiological examinations and fluorodeoxyglucose positron emission tomography (FDG-PET) scan, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin, and negative pressure wound therapy were initiated, but failed to achieve healing. Total sternectomy and pectoralis flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.

Unusual complications of bone wax at the skull base

Objective This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. Method The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. Results In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. Conclusion The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.

Mucormycosis osteomyelitis after anterior cruciate ligament reconstruction

Aims Our purpose was to describe an unusual series of 21 patients with fungal osteomyelitis after an anterior cruciate ligament reconstruction (ACL-R). Methods We present a case-series of consecutive patients treated at our institution due to a severe fungal osteomyelitis after an arthroscopic ACL-R from November 2005 to March 2015. Patients were referred to our institution from different areas of our country. We evaluated the amount of bone resection required, type of final reconstructive procedure performed, and Musculoskeletal Tumor Society (MSTS) functional score. Results A total of 21 consecutive patients were included in the study; 19 were male with median age of 28 years (IQR 25 to 32). All ACL-R were performed with hamstrings autografts with different fixation techniques. An oncological-type debridement was needed to control persistent infection symptoms. There were no recurrences of fungal infection after median of four surgical debridements (IQR 3 to 6). Five patients underwent an extensive curettage due to the presence of large cavitary lesions and were reconstructed with hemicylindrical intercalary allografts (HIAs), preserving the epiphysis. An open surgical debridement was performed resecting the affected epiphysis in 15 patients, with a median bone loss of 11 cm (IQR 11.5 to 15.6). From these 15 cases, eight patients were reconstructed with allograft prosthesis composites (APC); six with tumour-type prosthesis (TTP) and one required a femoral TTP in combination with a tibial APC. One underwent an above-the-knee amputation. The median MSTS functional score was 20 points at a median of seven years (IQR 5 to 9) of follow-up. Conclusion This study suggests that mucormycosis infection after an ACL-R is a serious complication. Diagnosis is usually delayed until major bone destructive lesions are present. This may originate additional massive reconstructive surgeries with severe functional limitations for the patients. Level of evidence: IV Cite this article: Bone Joint Open 2020;2(1):3–8.

Successful outcome of disseminated candida tropicalis osteomyelitis on remission induction for childhood Philadelphia chromosome–positive acute lymphoblastic leukemia

Invasive fungal infection (IFI) is one of the most challenging complications in children with acute lymphoblastic leukemia (ALL) treatment, but acute fungal osteomyelitis (OM) is rarely encountered. Here, we describe a case of Candida tropicalis osteomyelitis in a 10-year-old patient with Philadelphia chromosome (Ph)–positive ALL. He was on remission induction therapy at the time of neutropenia, and abscess developed in the right arm. The blood and bone cultures were positive for Candida tropicalis. Antibiotics and anti-fungal were started. A magnetic resonance of the arm reveal in intraosseous abscess, suggestive of OM. Surgical irrigation and debridement of the bone were performed immediately. The patient was effectively treated with antifungal therapy and ALL treatment. Now he is full recovery, having complete clinical remission but with sequelae visible by MRI. He is taking oral posaconazole for consolidation until disappearance of the lesion shadows on MRI and having subsequent cycles of chemotherapy in parallel. The recommended treatment for candida osteomyelitis in Ph-positive ALL patients is fungicidal agent combined with surgery and modification chemotherapy with dasatinib. Using combined modalities of treatment seem to be crucial in the successful management of Ph-positive ALL.