Tibial Osteomyelitis Caused By Gordonia Bronchialis In An Imuunocompetent Patient: A Case Report

1352 words - 5 pages

A 22 year old healthy, immunocompetent female with no past medical history underwent an arthroscopic knee surgery for a left anterior cruciate ligament and left lateral meniscal tears following a sport related injury. She had a reconstruction with hamstring auto graft from the same leg and a partial meniscectomy. 3 months after the surgery, she developed 2 areas of erythema, swelling, and pain around the harvest incision site with small abscess formation which was draining purulent discharge. She was afebrile with no systemic symptoms. At that time, she was seen at an urgent care facility and was prescribed bactrim for which she developed an allergic reaction a week after. Subsequently, she was seen at the orthopedic clinic for lack of improvement of her localized symptoms. She underwent incision and drainage of the abscess, and some bloody fluid was drained and sent for cultures. Meanwhile, she was started on Augmentin 825 mg po bid for 2 weeks. The culture grew branching gram-positive bacilli, which were sent out for further identification. Preliminary results reported possible nocardia species. However, later on, it turned out to be Gordonia bronchiali. She continued to have pain and drainage from 2 small openings just below the knee so it was decided to go for surgical debridement. The patient had an excisional debridement of the bone and hardware removal. She had an absorbable screw, which was in the tibial tunnel. The debridement was not done to the level of the knee joint. Tissue cultures again grew Gordonia bronchialis. The patient was put on Vancomycin empirically after the surgical debridement until the susceptibilities came back. The bacterium was sensitive to all tested antibiotics including amikacin, amoxicillin, clavulanate, ceftriaxone, ciprofloxacin, clarithromycin, doxycycline, imipenem, linezolid, minocycline, moxifloxacin, Bactrim, and tobramycin. Thus, patient was switched to oral Ciprofloxacin for 4 weeks after which the wound healed completely. There was no drainage or redness. Patient remained asymptomatic afterwards with no sings of recurrent infection.
Gordonia species are aerobic actinomycetes that rarely infect humans, often in the setting of intravascular catheter infections. Gordonia related Infections usually affect immunocompromised and rarely occur in immunocompetent patients [1]. In 1971, the Gordonia genus was differentiated from other aerobic actinomycetes [2]. Few reports of different infections due to several Gordonia species have been reported in recent years. A study in Thailand reported 171 aerobic actinomycetes isolates sent to the National Institute of Health for identification between 1996 and 2003, of which 6 % were Gordonia species [3]. Different types of infections caused by Gordonia species have been reported in the literature, including, but not limited to, sternal wound infections, otitis externa, skin and soft tissue infections [4, 5, 6, 7]. The species isolated in our...

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