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Case Reports
. 2024 Mar 27;10(7):e28730.
doi: 10.1016/j.heliyon.2024.e28730. eCollection 2024 Apr 15.

Osteomyelitis of the femur caused by Metamycoplasma orale in an immunocompromised patient using metagenomic next-generation sequencing: A case report

Hanxiao Zhu  1 , Jingzhi Zhu  2   3 , YiFei Wang  4 , Xiaotong Xi  2   3 , Keyi Wang  1 , Yongkang Wang  1 , Ran Ding  2   3 , Hang Li  1
Affiliations
Case Reports

Osteomyelitis of the femur caused by Metamycoplasma orale in an immunocompromised patient using metagenomic next-generation sequencing: A case report

Hanxiao Zhu et al. Heliyon. .

Abstract

Background: Metamycoplasma orale (M.orale), a symbiotic bacterium observed in the human oral cavity, is generally regarded as non-pathogenic to humans. Although infrequent, symptomatic infections caused by M.orale may occur in individuals with compromised humoral immunity. Accurate identification and early diagnosis of M.orale still present significant challenges due the limitations associated with conventional detection methods. Although metagenomic next-generation sequencing (mNGS) is currently widely utilized in clinical practices and exhibits a remarkable specificity and sensitivity for detecting various pathogens, its application in the diagnosis of M.orale-induced osteomyelitis remains largely unexplored.

Case description: In this report, we present a case study of osteonecrosis caused by M.orale in a 20-year-old female patient with nephrotic syndrome and other comorbidities. She was administered long-term hormone therapy and immunosuppressants, leading to her admission to the hospital due to recurrent fever, hip abscess and left thigh pain. Imaging examination revealed bilateral mid-femoral lesions, with the extensive nature of the left femoral lesion suggesting a potential secondary infection. Although no pathogen was detected in pus culture, mNGS analysis identified M.orale in the sample. Following treatment with doxycycline and levofloxacin, the patient's symotoms improved and she was discharged with favorable outcomes.

Conclusion: mNGS enables rapid identification of etiology in patients with osteomyelitis caused by the rare pathogen M.orale. This case accentuate the strength of mNGS for early detection and targeted clinical treatment of infectious diseases caused by uncommon pathogens.

Keywords: Case report; Immunocompromise; Metagenomic next generation sequencing; Metamycoplasma orale; Osteomyelitis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
The findings from the in-hospital examination. (A) Magnetic resonance imaging (MRI) of the patient before surgery. (B) MRI examination at 2 months post surgery. (C) MRI examination at 8 months post surgery. The arrow points to the lateral thigh muscle flap that fills the medullary cavity. (D) CRP data of the patient during follow-up in hospital.
Fig. 2
Fig. 2
MNGS results. (A) M.orale detceted in pus by mNGS. (B) Coverage picture of M.orale. The genome coverage of M.orale is 53.835%.
Fig. 3
Fig. 3
QPCR verification results of M.orale. blue line: negative control; green line: positive control; red line: the pus sample of the patient.
Fig. 4
Fig. 4
Patient progression timeline.
See this image and copyright information in PMC

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