Non-vertebral Veillonella species septicemia and osteomyelitis in a patient with diabetes: a case report and review of the literature

Abstract

Introduction: Veillonella is a nonfermentative, strictly anaerobic, Gram-negative coccus that forms part of the human gastrointestinal tract, mouth and vaginal flora. Like other anaerobic infection, Veillonella species usually are involved in polymicrobial processes, which make it difficult to determine their pathogenic role. Isolation of a clinically significant Veillonella species is rare and V. parvula is the most common one reported to cause infection in humans. The most frequently reported infection caused by V. parvula is osteomyelitis, almost always in association with bacteremia.

Case presentation: Here, we describe a rare case of nonvertebral osteomyelitis and septicemia caused by Veillonella species in a 49-year-old Saudi man with diabetes. Initial treatment with ciprofloxacin was associated with treatment failure and poor response. Identification of the organism was essential for the selection of appropriate treatment. There have been only seven previous reports of Veillonella vertebral osteomyelitis and one report of V. parvula foot osteomyelitis with sepsis in the literature. This is the second case of Veillonella nonvertebral osteomyelitis associated with septicemia reported to date.

Conclusions: Veillonella species should be considered a true pathogen in diabetic patients with osteomyelitis and those with underlying immune suppression, particularly if the organism is isolated from blood. The isolation of those obligate anaerobes from blood may signal the presence of severe underlying disease and the probable need for timely surgical intervention.

Figure 1

Left foot magnetic resonance imaging. (A) A left foot MRI scan revealed a fracture in the calcaneus. (B) The calcaneus bone is separated into two segments ((A) and (P)) with evidence of anterior segment osteomyelitis and a deep, infected ulcer (arrows).

Figure 2

Blood agar plate after 48 hours of anaerobic incubation showing tiny colonies of Veillonella organism.

Figure 3

Gram stain from anaerobic culture plate showing small Gram-negative cocci.