Osteomyelitis of the Fifth Toe after Human Bite

Tarik Zahouani^1, , Claudia Lopez¹, Liliana Burdea¹, Anyelina De LaCruz¹, Patrick Polonio¹, Catalina Marino¹ and Yekaterina Sitnitskaya¹

¹Department of Pediatrics of Lincoln Medical Center, New York, USA

Cite this paper

Tarik Zahouani, Claudia Lopez, Liliana Burdea, Anyelina De LaCruz, Patrick Polonio, Catalina Marino and Yekaterina Sitnitskaya. Osteomyelitis of the Fifth Toe after Human Bite. American Journal of Medical Case Reports. 2016; 4(10):346-348. doi: 10.12691/AJMCR-4-10-5

Abstract

Human bite wounds are the third leading cause of bite wounds seen in the emergency departments. Osteomyelitis due to animal bite is well known. However there are very few reports of osteomyelitis secondary to human bite. We present a case of osteomyelitis of the fifth toe due to a human bite. A 13 year old previously healthy Male developed severe pain, redness and swelling with oozing from the wound, 2 days after sustaining a human bite to the right foot. The Magnetic Resonance Imaging (MRI) showed a mild T2 prolongation and enhancement within the proximal phalanx of the fifth digit consistent with osteomyelitis. He was treated for 4 weeks: Ampicillin/Sulbactam for 5 days followed by 11 days of Amoxicillin/Clavulanic and Clindamycin for 25 days. Human bite wounds are a source of serious morbidity with hand and foot wounds due to higher risk of infection. The oral cavity harbors more than 300 different bacterial species. The most common bacteria isolated from bite wounds are Streptococcus sp., Staphylococcal epidermis and Staphylococcus aureus. Anaerobes such as Eikenella, Fusobacterium, Peptostreptococcus, Prevotella and Porphyromonas species are also common. The teeth can cause a deep laceration implanting oral and skin organisms into the joint capsules causing septic arthritis or osteomyelitis with signs and symptoms appearing within 24 to 72 hours. The absence of fever or laboratory evidence of serious bacterial infection in our patient is due to non-hematogenous, contiguous nature of spread of infection. Without imaging by MRI, osteomyelitis would have been missed in this case. Though rare, human bites to the distal extremities should be suspected and assessed for underlying osteomyelitis using MRI to guide appropriate length of antibiotic treatment.

Keywords

Osteomyelitis, toe, human bite, Magnetic Resonance Imaging, antibiotic

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Aziz H, Rhee P, Pandit V, Tang A, Gries L, Joseph B. The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. J Trauma Acute Care Surg. 2015 Mar; 78(3):641-8.
[2]	Tan W, Wazir N, Chiu C, Ko M. Chronic osteomyelitis secondary to human bite: a case report. Malays Orthop J. 2012 Nov; 6(3): 40-1.
[3]	Jaindl M, Grünauer J, Platzer P, et al. The management of bite wounds in children--a retrospective analysis at a level I trauma centre. Injury. 2012 Dec; 43(12):2117-21.
[4]	American Academy of Pediatrics. Bite Wounds. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the committee on infectious diseases. American Academy of Pediatrics; 2015; 205-210.
[5]	Rothe K, Tsokos M, Handrick W. Animal and Human Bite Wounds. Dtsch Arztebl Int. 2015 Jun 19;112(25):433-43.
[6]	Brook I. Management of human and animal bite wound infection: an overview. Curr Infect Dis Rep. 2009 Sep; 11(5):389-95.
[7]	Gonzalez MH, Papierski P, Hall RF Jr. Osteomyelitis of the hand after a human bite. J Hand Surg Am. 1993 May;18(3):520-2.