Treatment of Eikenella corrodens and Actinomyces odontolyticus foot abscess in a penicillin-allergic patient

Abstract

Objective: To report a case of Eikenella corrodens and Actinomyces odontolyticus foot abscess secondary to a toothpick puncture in a penicillin-allergic patient that was successfully treated with a long-term course of doxycycline.

Case summary: A 39-year-old woman with diabetes mellitus type 2 and hyperlipidemia presented with difficulty ambulating as well as pain and swelling of her right foot. Prior to presentation, she sustained a toothpick puncture to her right foot; she removed the toothpick intact and did not know whether it had been used. Due to a penicillin allergy, she began treatment with levofloxacin, which was changed to clindamycin one day later. The patient was diagnosed with right Achilles tendonitis/cellulitis and was discharged on a one-week course of clindamycin. Twenty-five days later she was readmitted, complaining of pain and swelling in the same area, which this time presented as an abscess. Upon this admission, vancomycin and levofloxacin were initiated and incision and drainage (I & D) was performed. Cultures and sensitivities from I & D were significant for E. corrodens and A. odontolyticus, and treatment was changed to intravenous doxycycline 100 mg every 12 hours for 10 weeks. Oral doxycycline 100 mg every 12 hours was then used for 3 months, and treatment was successful.

Discussion: E. corrodens and A. odontolyticus are 2 slow-growing organisms that are part of the normal oropharyngeal flora. Extraoral infections due to either of these organisms may be difficult to treat and might need lengthier treatments than are necessary for most infections. First-line treatment for such infections is penicillins and cephalosporins; however, in a patient with penicillin allergy, treatment options become limited, as there is potential cross-reactivity with other agents.

Conclusions: Patients with infections secondary to E. corrodens and/or A. odontolyticus in whom penicillin allergy is a concern can be treated effectively with doxycycline.