Culture-Negative Osteomyelitis: Is it Haemophilus haemolyticus?

Abstract

Case: A 50-year-old woman presented to our emergency department with severe intractable atraumatic right hip pain. She was admitted to the hospital, and an orthopaedic consult was requested. She does have a known history of right hip osteoarthritis, but does not actively follow with an orthopaedic surgeon. Advanced imaging was obtained followed by computed tomography–guided biopsy of the right hip to include cartilage and bone. The cultures were negative for growth. An incision and debridement were performed, and necrotic bone was found. Subsequently, an antibiotic spacer was placed secondary to osteomyelitis. Blood cultures and tissue polymerase chain reaction 16S ribosomal RNA were positive for Haemophilus haemolyticus. Discussion: Culture-negative osteomyelitis remains a treatment challenge. Several organisms have the potential to cause osteomyelitis. Unfortunately, a high percentage of patients have fallen into the category of culture-negative disease. This is a case report discussing an immunocompetent patient with a rarely reported cause of osteomyelitis and how to assist with definitive diagnosis of culture-negative cases.