Recalcitrant Chest Wall Aspergillus Fumigatus Osteomyelitis After Coronary Artery Bypass Grafting: Successful Radical Surgical and Medical Management

• Published in: The Annals of thoracic surgery Vol. 79; no. 3; pp. 1057 - 1059
• Main Authors: Elahi, Mohammed M., Mitra, Amit, Spears, Julia, McClurken, James B.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2005; Elsevier Science
• Subjects: Antifungal Agents - therapeutic use; Aspergillosis - drug therapy; Aspergillosis - surgery; Aspergillus fumigatus; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Coronary Artery Bypass - adverse effects; Human bacterial diseases; Humans; Infectious diseases; Itraconazole - therapeutic use; Male; Medical sciences; Middle Aged; Osteomyelitis - drug therapy; Osteomyelitis - microbiology; Osteomyelitis - surgery; Remission Induction; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Thoracic Wall; 5; Respiratory disease; Diseases of the osteoarticular system; Coronary artery; Surgical anastomosis; Thorax; Radical; Fungi; Medicine; Treatment; Aortocoronary; Bypass; Surgery; Osteitis; Graft; Fungi Imperfecti; Aspergillus fumigatus; Chest wall; Thallophyta
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2003.09.119

This report describes a 62-year-old male diabetic patient with persistent chest wall osteomyelitis that developed after repeat coronary artery bypass grafting. The chronic infection was localized to the right anterior chest wall and refractory to medical and surgical treatment including long-term antiobiotics, five separate intraoperative debridements, and reconstruction with vascularized omentum over a two-year period at outside institutions. Aggressive surgical debridement with flap reconstruction resulted in definitive management. The organism isolated from multiple intraoperative bone, cartilage, and tissue cultures yielded Aspergillus fumigatus; therapy with itraconazole was utilized for 6 months. Surgical management of osteomyelitis and costochondritis is reviewed accompanied by a literature review on this uncommon cause of chronic chest wall infection.