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Pathological Fracture in Acute Osteomyelitis of Long Bones Secondary to Community-Acquired Methicillin-Resistant Staphylococcus aureus: Two Cases and Review of the Literature

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ABSTRACT

Pathologic fracture is a rare complication of acute bacterial osteomyelitis in adults. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasingly reported in skin and soft tissue and systemic infections in children and adults, including many cases of osteomyelitis. We recently treated two adult patients with acute osteomyelitis of long bones secondary to CA-MRSA complicated by a pathologic fracture. In both patients, the primary source of dissemination to the bone was a skin and soft tissue infection. We speculate that virulence factors specific for CA-MRSA currently circulating in the United States may predispose to a complicated course of acute osteomyelitis.

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Case 1

A 46-year-old woman was admitted to the hospital because of a pathologic fracture of the right humerus. Four months prior to the admission the patient noted a “boil” on the left lower leg with swelling, warmth, and purulent drainage. She was given a 7-day course of oral trimethoprim/sulfamethoxazole (one double-strength tablet twice daily) and the lesion resolved. The patient had no fever, chills, or sweats. There was no history of trauma or injections, but her daughter was reported to have had

Discussion

Pathologic fractures occur as a result of a malignancy, underlying bone disease, or infection.1 Chronic osteomyelitis is a recognized, although infrequent, cause of pathologic fractures because bone resorption is balanced by the formation of new, albeit abnormal, bone.1 Pathologic fracture is a rare complication of acute bacterial osteomyelitis of long bones in adults.3 Most cases reported in the modern medical literature have occurred in children, including those with an underlying sickle cell

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