Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report

Journal of Medical Case Reports

Omar Féres¹  José Joaquim Ribeiro da Rocha¹  Mariane Nunes de Nadai¹  Rosemary Furlan Daniel¹  Tales Rubens de Nadai¹ 

[1] Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, Brazil Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil

关键词: Sternum;    Primary Osteomyelitis;    Hyperbaric Oxygen Therapy;   

Others  :  1181152
DOI  :  10.1186/1752-1947-7-167

 received in 2012-12-09, accepted in 2013-05-30,  发布年份 2013

【 摘 要 】

Introduction

Primary osteomyelitis of the sternum is a rare condition, which accounts for 0.3% of all cases of osteomyelitis reported in the literature. The diagnosis requires a high degree of suspicion and confirmation by percutaneous biopsy. The treatment consists of resection of the periosteum and affected bone. Despite reports of successful conservative treatment using antibiotics alone, early surgical intervention plus bacterial control is the definitive treatment; it reduces morbidity, and is the most cost-effective approach for the patient. We report a case of primary osteomyelitis surgically treated with debridement and antibiotics, followed by hyperbaric oxygen therapy.

Case presentation

A 39-year-old Brazilian man without a significant medical history presented with primary osteomyelitis. After a normal chest radiograph and normal laboratory test results, he was treated with 2 weeks of nonsteroidal anti-inflammatory drugs. One month later a presumptive diagnosis of Tietze syndrome was made and he was prescribed prednisolone (60mg/day) for 3 weeks. The following month he presented to our service with swelling, redness, and warmth in the area between his left third and fourth ribs. Subsequent magnetic resonance imaging revealed a large collection of liquid (8.8×6.8×20.2cm) in his chest wall, between the body and the manubrium of the sternum. An area of soft, friable tissue with a large amount of pus was found in his sternum during surgical debridement. Subsequent treatment consisted of antibiotic therapy using metronidazole and cefotaxime plus hyperbaric oxygen therapy. On postoperative day 10 the incision was sutured. The patient was discharged on postoperative day 15 on a regimen of oral ciprofloxacin, and completed hyperbaric oxygen therapy as an out-patient.

Conclusions

The satisfying outcome of this patient reflects the quick action to promote surgical debridement and use of antibiotics, which are both recommended treatments. The closure of the wound in 10 days after debridement suggests that the hyperbaric oxygen therapy might have indirectly, but not conclusively, aided in the premature closure of the wound, avoiding a longer healing by second intention or muscle flap rotation closure.

【 授权许可】

   
2013 de Nadai et al.; licensee BioMed Central Ltd.

【 图 表 】

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