The inevitable outcome of chronic recurring actinomyces osteomyelitis of the hand.

discharge, multiple nodules, and deformity of his right hand (Figure 1). His symptoms had begun with pain and swelling without trauma 16 years ago. He had been diagnosed with chronic actinomyces osteomyelitis and underwent medical therapy and surgical debridement in four different incidents. He had been on antibiotics irregularly for 12 years. Deformity was evident, there was no active wrist movement; supination and pronation were severely restricted. Erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were elevated (Sed: 120 mm/h (0-20), CRP: 4.7 mg/dL (0-0.5)), but there was no leukocytosis. Chronic osteomyelitis of the distal forearm and hand on radiological examination. Anaerobic cultures of the pus were negative, whereas aerobic cultures yielded Staphylococcus aureus. Biopsy specimens from the nodules confirmed the previous diagnoses of chronic Actinomyces israelii. No additional diagnostic tests were necessary, and the patient underwent above elbow limb amputation. There were no complications following the surgery. A twelve month course of ampicillin/sulbactam was initiated. Involvement of the upper extremities is very rare, and only case reports are present in the literature. So far, only 15 cases with actinomyces osteomyelitis of the hand are reported. Of these, 13 have involved metacarpals and phalanxes, and 2 have involved the carpal bones. (1-4) Our case is distinct from the literature as it is the only case with all of the bones distal to the mid-forearm involved. Typical presentation and radiographic examination may resemble tuberculosis, fungal infections or malignancies. Anaerobic culture and biopsy are necessary for definitive diagnosis (1, 2). It is not always possible to isolate the microorganism. Identification of yellow sulphur granules in histological specimens is pathognomic (1-4). Mah et al. have reported Actinomyces meyeri osteomyelitis in a 40 year-old patient in the fifth proximal phalanx. (2) Other cases in the literature are caused by Actinomyces israelii. In three of these cases, anaerobic cultures were negative (1-4). In our case, prolonged disease, poor patient compliance and failure to eradicate the The Inevitable Outcome of Chronic Recurring Actinomyces Osteomyelitis of The Hand