rifampin and Myositis

Topics: Azithromycin; Clarithromycin; Drug Therapy, Combination; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Middle Aged; Mycobacterium Infections, Nontuberculous; Myositis; Nontuberculous Mycobacteria; Popliteal Cyst; Rifampin

BACKGROUND Foot ulcers are high-morbidity and debilitating complications of diabetes mellitus, and carry significantly increased rates of associated major amputations. They contribute to significantly worse quality of life. Osteomyelitis is a frequent complication of diabetic foot ulcers, since bacteria can contiguously spread from soft tissues to the bone, involving the cortex first and then the bone marrow. Unfortunately, clinically unsuspected osteomyelitis is frequent in persisting diabetic foot ulcers. It is associated with limb amputations and increased mortality. CASE REPORT We describe a 76-year-old man with long-standing insulin-treated type 2 diabetes, who experienced extensively drug-resistant Enterococcus faecalis diabetic foot myositis and osteomyelitis associated with sepsis. He was successfully treated with surgical debridement combined with the administration of teicoplanin plus rifampicin in the outpatient setting, completing, in total, a twelve-week course of antibiotic therapy. CONCLUSIONS Clinically unsuspected osteomyelitis in patients with persisting diabetic foot ulcers has been associated with infections from highly resistant bacteria. Early and accurate diagnosis of diabetic foot osteomyelitis, as well as proper therapeutic approach (antimicrobial and surgical), is of great importance to reduce the risk of minor and major amputations, septic shock leading to multiple organ failure, and overall mortality.

Topics: Aged; Anti-Bacterial Agents; Diabetes Mellitus, Type 2; Diabetic Foot; Enterococcus faecalis; Humans; Male; Myositis; Osteomyelitis; Outpatients; Pharmaceutical Preparations; Quality of Life; Rifampin; Teicoplanin

Topics: Dapsone; Humans; Leprostatic Agents; Leprosy; Male; Middle Aged; Myositis; Rifampin; Treatment Outcome

A patient being treated for sickle cell crisis developed swollen, painful, indurated, discoloured thighs after several days in hospital. Imaging revealed the presence of multiple small abscesses in the muscle and methicillin resistant Staphylococcus aureus (MRSA) was cultured from aspirated fluid. Pyomyositis usually occurs in association with damaged muscle and impaired host defences. Staphylococcus is the most frequent organism involved. It is not a common complication of sickle cell disease, although it may be under diagnosed. Availability of advanced imaging techniques facilitates early diagnosis of pyomyositis.

Topics: Adult; Anemia, Sickle Cell; Female; Fusidic Acid; Humans; Leg; Magnetic Resonance Imaging; Methicillin Resistance; Myositis; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Topics: Aged; Anti-Infective Agents; Antibiotics, Antitubercular; Ciprofloxacin; Femur; Humans; Male; Muscle, Skeletal; Myositis; Osteomyelitis; Recurrence; Rifampin; Staphylococcal Infections