Treatment of Fusarium Osteomyelitis in a Diabetic Foot Ulcer Complicated by Antineoplastic Chemotherapy

Abstract

Introduction. Diabetic foot osteomyelitis (DFO) is a severe complication of diabetic foot ulcerations (DFUs). Fusarium osteomyelitis in patients who are severely immunocompromised is not well documented in current literature. Fusarium is an invasive fungal species that has been shown to respond poorly to antifungal therapy alone, and bone debridement is usually required. Treatment for DFO may consist of surgical amputation, antimicrobial therapy, and/or conservative surgery (CS) or bone debridement. Case Presentation. The authors present a case of Fusarium osteomyelitis in a 77-year-old female with type 2 diabetes and acute myeloid leukemia, simultaneously undergoing chemotherapy. The patient had a DFU to the second digit with DFO suggested by magnetic resonance imaging. Bone cultures revealed coagulase-negative staphylococci and Fusarium species. Due to the patient’s severely immunocompromised state, they were treated with CS and joint antifungal and antibiotic therapy. The DFU was healed in 6 weeks with no reoccurrence at 6 months. Conclusions. This case report, to the authors’ knowledge, is the first to demonstrate successful remission of Fusarium osteomyelitis with a conservative procedure and adjunct antifungal therapy in an immunocompromised patient.