Spontaneous tibiotalar arthrodesis as a complication of acute tibial osteomyelitis due to Panton-Valentine leukocidin-producing Staphylococcus aureus: a case report

Abstract

Introduction: Strains of Panton-Valentine leukocidin-producing Staphylococcus aureus producing a new pattern of disease have emerged worldwide. Infection with these bacteria typically presents as a life-threatening infection of soft tissues and bones, and may cause potentially devastating consequences.

Case presentation: We report a case of osteoarticular infection caused by Panton-Valentine leukocidin-producing Staphylococcus aureus. A 12-year-old Caucasian girl presented with acute osteomyelitis of the tibia associated with toxic shock syndrome, which was complicated by an unexpected spontaneous ankle arthrodesis.

Conclusions: Osteoarticular infections due to Panton-Valentine leukocidin-producing Staphylococcus aureus appear to be severe, and are characterized by their tendency to evolve towards serious complications. This case highlights the need for early and aggressive surgical procedures in conjunction with appropriate antimicrobial therapy and regular long-term follow-up.

Figure 1

Initial conventional X-ray of the affected tibia. Early frontal and lateral conventional X-rays only reveal discrete peritibial soft tissue infiltration.

Figure 2

Initial magnetic resonance images of the affected tibia. Overall extension is best understood on magnetic resonance images with extensive heterogeneous medullar and pericortical enhancement on T1-weighted fat-suppressed coronal images.

Figure 3

Initial magnetic resonance images of the affected tibia. The peripheral reactive effusion is explicit on liquid sensitive inversion-recovery T2-weighted axial images.

Figure 4

Conventional X-ray of the affected tibia 42 days after surgical drainage and the onset of antibiotic treatment. Frontal X-ray control after pharmacological and surgical treatment illustrates the diffuse bone remodeling and sclerosis. Major narrowing of the tibiotalar joint space illustrates the aggressiveness of the overall infectious process.

Figure 5

Late control X-rays of the affected tibia three and a half months after disease onset. Extensive bone remodeling consisted of cortical thickening, diffuse sclerosis, anatomical deformation and tibiotalar fusion.