Successful treatment of Scedosporium aurantiacum osteomyelitis in an immunocompetent patient.

BACKGROUND Bacterial infections are a well-known complication of traumatic amputations. In cases involving contact with soil or water contaminated with manure, one also must be aware of infections with fungi, particularly Scedosporium spp. We report on an immunocompetent trauma patient with an infection caused by a recently described Scedosporium species, S. aurantiacum. METHODS Case report and literature review. RESULTS In a 36-year-old healthy man, entrapment of the right leg resulted in a traumatic amputation just below the knee and contamination of the wound with manure. Six weeks after the initial surgical debridement, he developed a phlegmon. Cultures yielded Staphylococcus aureus and Pseudomonas aeruginosa, and treatment with ciprofloxacin and clindamycin was started. After several weeks, a fistula developed, and roentgenograms demonstrated osteomyelitis. A pure culture of Scedosporium was grown from bone fragments and was identified as S. aurantiacum by sequencing of the rDNA internal transcribed spacer 1 region. Following debridement, the wound was drenched in 0.2% polyhexamethylene biguanide for four minutes. A pre-operative culture showed growth of S. aureus only. Postoperatively, clindamycin, ciprofloxacin, and voriconazole were started and continued for 12 weeks. At the last follow-up, 15 months after the trauma and nine months after cessation of the antimicrobial agents, the patient had no signs of osteomyelitis. CONCLUSION To our knowledge, this is the first case of osteomyelitis caused by S. aurantiacum. The patient was treated successfully by a combination of surgery and voriconazole.