Bilateral tibial chronic osteomyelitis due to Pantoea agglomerans in a patient with sickle cell disease

Abstract

A 20-yr-old Gabonese man with homozygous SS sickle cell disease and a mechanical aortic valve had leg pain, which was permanent for 2 months. He was healthy and afebrile. A 4-cm abscess was found at the anterior aspect of the left leg. X-ray showed periosteal reaction of upper part of both tibias. MRI showed the subcutaneous abscess of the left leg and replacement of marrow fat with fluid in both tibias (Fig. 1A and B). CT scan displayed cortical destruction of both tibias and the abscess extending into the centromedullary cavity. A fine needle aspirate from the collection of the left leg evacuated pus, with presence of Gram-negative bacilli, identified as Pantoea agglomerans on 16 S rDNA sequencing and producing CTX-M-15 extended-spectrum β-lactamase. Blood cultures grew negative. No other site of infection was found. Treatment with imipenem and amikacine was given during 3 weeks, then imipenem and colimycine during 3 weeks, along with soft tissue and bone debridement of the left leg. The patient rejected any surgery of the right leg.