|Beitragstitel||A rare Case of Brucellosis in Switzerland: Osteomyelitis of the Pediatric Foot|
Brucellosis is one of the most common zoonotic bacterial infections in developing countries. Transmitted mainly by drinking unpasteurized milk, children seem to be more often affected than adults. Undulating fever, fatigue, musculoskeletal pain are common symptoms. Osteoarticular involvement is the most frequent complication; affecting most frequently the sacroiliac and spinal joints. Diagnostic measures include physical examination, laboratory tests, radiological imaging, and biopsies for microbiological and histological analysis. Treatment of osteoarticular brucellosis is by antibiotic therapy; however, surgical treatment is necessary in case of non-responsiveness to antimicrobial therapy.
A case presentation of an 8-year-old boy admitted to our hospital due to increasing left foot pain and swelling. Known for recurrent episodes of polyarticular arthritis, he was being treated by a rheumatologist with analgesics and cortisone infiltrations for approximately six months. On clinical examination, he presented with swelling and erythema of the ankle and of the midfoot and associated with pain and limited range of motion. Laboratory findings showed normal inflammation parameters.
Standard radiographs and ultrasonography of the foot demonstrated signs of osteomyelitis of the navicular bone with a concomitant abscess around the talonavicular joint confirmed by magnetic resonance imaging (MRI).
Surgical debridement of the navicular bone and packing with gentamicin-impregnated foam was performed. Initially, the intraoperative microbiological biopsies were negative; however, the Brucella-specific agglutination test, IgM‐IgG combined antibody test and the eubacterial PCR resulted positive. The initial treatment with co-amoxicillin (amoxicillin + clavulanic acid) was replaced after 3 days by gentamicin. After two weeks, the gentamicin substituted by oral rifampicin and doxycycline for a total therapy of 3 months.
At our postoperative follow-up at 6 months, the patient was completely healed, asymptomatic and had recovered complete range of motion.
Brucellosis is a rare cause of osteomyelitis in children in Switzerland, but its consequences may be disastrous if missed. Brucellosis should be considered as a differential diagnosis in patients, especially immigrants, with unspecific symptoms, including joint pain and fever. We also recommend PCR analysis in case of negative microbiological cultures.