Introduction
Aggregatibacter actinomycetemcomitans is an anaerobic gram negative cocco-bacillus most commonly associated with aggressive periodontitis.1 Extra-oral infections are rare and occur through haematogenous spread from infected periodontium to associated facial regions.2 We report the first case of distant osteomyelitis (foot) in a child.
Case Report
A 12 year old boy presented with a two week history of pain, swelling, and purulent discharge from his right great toe, on a background of intermittent pain for 12 months. He was afebrile and systemically well, with no past history of dental disease. Examination revealed a crusted wound on the medial aspect of the toe, mild swelling around the interphalangeal joint and full and painless range of motion, with no erythema or tenderness. Dentition was normal. Inflammatory markers and white cell count were normal. Gram stain of pus showed gram positive and gram negative bacilli, but wound culture and blood cultures were negative. X-ray showed a lytic lesion in the proximal phalanx of the great toe, and bone scan showed sclerotic and cystic changes in the proximal phalanx, consistent with chronic osteomyelitis. The wound was debrided in theatre, and a sinus tract was found with a collecition of pus in the proximal phalanx, and no devitalised bone. Tissue of resected bone grew Aggregatibacter actinomyctemecomitans after six days. The organism was fully sensitive to ampicillin and cefotaxime, and was managed with intravenous antibiotics for 7 days, followed by 12 weeks of high dose oral amoxicillin.
Discussion
We have described the first case of chronic osteomyelitis in a paediatric patient caused by A. actinomycetemcomitans. The insidious presentation and late diagnosis was typical of this organism. Interestingly, there was no clear precipitant of dental disease, as has been found in most previous case reports of A. actinomycetemcomitans osteomyelitis.
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