ABSTRACT
Herein, we describe a combination of clinical, microbiologic, and histopathologic findings significantly associated with osteomyelitis in chronic granulomatous disease. When present, these features should raise the suspicion of underlying chronic granulomatous disease. In patients with these findings, anti-infective prophylactic measures aiming to cover highly prevalent microorganisms, as well as aggressive therapeutic measures, should be strongly encouraged.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Chemoprevention , Granulomatous Disease, Chronic/complications , Granulomatous Disease, Chronic/microbiology , Osteomyelitis/microbiology , Osteomyelitis/pathology , Aspergillosis/drug therapy , Aspergillosis/microbiology , Aspergillosis/pathology , Aspergillosis/physiopathology , Aspergillus/isolation & purification , Bone and Bones/pathology , Case-Control Studies , Child , Child, Preschool , Granulomatous Disease, Chronic/pathology , Granulomatous Disease, Chronic/physiopathology , Humans , Infant , Mycoses/drug therapy , Mycoses/microbiology , Mycoses/pathology , Mycoses/physiopathology , Osteomyelitis/drug therapy , Osteomyelitis/physiopathology , Penicillium/isolation & purification , Serratia Infections/drug therapy , Serratia Infections/microbiology , Serratia Infections/pathology , Serratia Infections/physiopathology , Serratia marcescens/isolation & purificationABSTRACT
Infections due to Penicillium species other than P.marneffei are rare. We identified a boy with X-linked chronic granulomatous disease (X-CGD) with a pulmonary nodule and adjacent rib osteomyelitis caused by Penicillium piceum. The only sign of infection was an elevated sedimentation rate. P. piceum was isolated by fine needle aspirate and from excised infected tissues. Surgical removal and one year of voriconazole treatment were very well tolerated and led to complete recovery. Microbiological, microscopic and molecular studies support the fungal diagnosis. P. piceum should be considered as a relevant pathogen in immunocompromised patients.