Schistosomiasis as causative organism for chronic osteomyelitis. Case report

INTRODUCTION AND IMPORTANCE: Osteomyelitis is an infection of the bone mainly caused by bacteria and rarely by fungi and parasites. Parasitic osteomyelitis (schistosoma) is a very rare and unique condition with a few literatures. CASE PRESENTATION: A 14-year- old boy presented with right upper arm sinus for 4 years and exposed bone for 1 year. He has a history of hematuria. Blood tests were normal, urine general was normal and no Ova was seen. In Radiological assessment, X-ray showed Sequestrum in the anterior part of the upper humerus with Involucrum, MRI showed abnormal expansion, cortical thickening and diffuse altered marrow signal in the shaft of humerus with multiple cortical defects, sinus tracts, peri-osseus enhancing sheets and collections. The patient underwent Sequestrectomy and samples were collected for culture & sensitivity and showed no growth, Acid Fast Bacilli was negative, Histopathology test showed marked mixed inflammatory infiltrate composed mainly of eosinophils surrounding numerous Ova of Schistosoma haematobium, the patient was shifted to Praziquantel, wound care and regular follow-up. Long term clinical & radiological follow up showed good healing and the patient was satisfied. CLINICAL DISCUSSION: Parasitic osteomyelitis caused by Schistosoma is a very rare, and unique condition with a limited published cases in literature. Janet.T.Scott et al. stated that Schistosoma Haematobium is associated with chronic Osteomyelitis during investigation about potential risk factors of Buruli ulcer, which recognized as emerging public health problem by WHO in 1997 in West Africa, that lead to severe complications like amputations. CONCLUSION: Schistosomiasis can cause chronic osteomyelitis, good history taking and examination, high index of suspicious, collection of adequate tissue samples and sending them to a reliable laboratory are the corner stone of diagnosis.