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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.

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Article

Osteomyelitis of the Fifth Toe after Human Bite

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


American Journal of Medical Case Reports. 2016, Vol. 4 No. 10, 346-348
DOI: 10.12691/ajmcr-4-10-5
Copyright © 2016 Science and Education Publishing

Cite this paper:
Tarik Zahouani, Claudia Lopez, Liliana Burdea, Anyelina De LaCruz, Patrick Polonio, Catalina Marino, 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.

Correspondence to: Tarik  Zahouani, Department of Pediatrics of Lincoln Medical Center, New York, USA. Email: Tarikzahouani@gmail.com

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.

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