Danijela Mataic M.D.             ST. LOUIS UNIVERSITY  
Bilateral shoulder osteomyelitis due to an anaerobic microorganism   
         
 

The patient is a 42 year old female with a history of intravenous drug abuse who presented with alcohol induced acute pancreatitis. She had a low grade fever, WBC of 11,300/mm3 and bibasilar pulmonary infiltrates. Blood cultures from the second day of hospitalization were positive for Streptococcus mitis and Clostridium sporogenes. The patient had no heart murmurs and transesophageal echocardiograms failed to demonstrate vegetation. Treatment with intravenous ceftriaxone and metronidazole for a possible right-sided endocarditis was begun. The patient continued to have fever, leukocytosis and increasing pain in both shoulders. Plain films and MRI were consistent with osteomyelitis and fasciitis. The patient underwent an open drainage procedure of shoulder joints. Purulent material was obtained, bone and synovial fluid cultures were positive for Clostridium sporogenes. The patient remained afebrile with normalization of her white blood cell count. She was discharged to a skilled nursing facility for 6 weeks of antibiotic therapy.

We have described an unusual case of bilateral, symmetric hematogenous osteomyelitis and arthritis with the anaerobe Clostridium sporogenes. The reported incidence of anaerobic osteomyelitis is less than 1% and may be the result of bacteremia. It is possible that IVDU was a portal of entry of bacteremia in this patient with subsequent seeding of shoulder joints. Treatment consists of a combination of surgical drainage and prolonged administration of high-dose antimicrobial therapy.