Refractory Osteomyelitis Caused by Mycobacterium aubagnense and Its L-Form: Case Report and Review of the Literature

Figures & data

Figure 1 (A) Diffuse low-density transparent areas can be seen in the lower part of the left femur and the upper part of the tibia. The boundary is unclear. The density of the patella is slightly uneven. The joint surface of the patella is narrow and rough, and the joint space is narrow. No abnormalities are found in the surrounding soft tissues. (B) Bone destruction is observed at up to a depth of approximately 2 cm inside the tibial tubercle, reaching deep into the medullary cavity.

Figure 2 Microscopic morphology (400 x) of L-form NTM. (red spheroids, arrows).

Figure 3 Morphology of L-form NTM (blue arrows) on electron microscopy.

Figure 4 Acid-fast bacilli, slightly curved, with a tendency to branch (arrows) are observed on microscopy after the reversion test.

Table 1 Characteristics of Cases of NTM Osteomyelitis Identified in the Literature Review

Study	Age/Sex	Pathogen	Underlying Condition	Position	Diagnosis Tools	Antibiotics	Surgical Treatment	Length of TREATMENT
Ashraf et al^Citation35	70/M	M. monacense	Diabetes	Vertebra	MRI, Culture, PCR	FOX, CIP, CLARY, IPM, LZD, MXF	Yes	11 months
Farsi et al^Citation36	49/M	M. farcinogenes	Operation	Tibia	MRI, Culture, MALDI-TOF, PCR	CIP, CLARY	Yes	6 months
Saad et al^Citation37	24/F	M. riyadhense	None	Vertebra	MRI, Biopsy, Culture, PCR	AZT, RFP, INH, PZD	No	13 months
Saad et al^Citation37	18/F	M. riyadhense	None	Frontal bone	MRI, Culture, PCR	MXF, INH, RFP, EMB	Yes	6 months
McGee et al^Citation38	45/M	M. phlei	Operation	Vertebra	MRI, Culture, Biopsy	VAN, AZM, MIN	Yes	12 months
Gray et al^Citation39	70/F	MAC	Immunosuppression	Vertebra	CT, Biopsy, DHT	AZT, EMB	Yes	12 months
Moral et al^Citation40	82/M	M. abscessus	Cataclasis	Vertebra	MRI, Culture, Biopsy, PCR	AMK, AZT, MEM	Yes	None
Elsayed et al^Citation41	56/F	M. haemophilum	None	Wrist, Ankle	X-ray, MRI, Biopsy, HPLC	CLARY, CIP, RFP,	Yes	2 years
Wong KP et al^Citation42	83/M	M. fortuitum	Diabetes	Ankle	DHT, HPLC	CLARY, DOX	Yes	12months
Bhatt et al^Citation43	50/F	M. kansasii	None	Elbow, Clavicle	X-ray, Culture, PCR	None	Yes	0 days*
Breda et al^Citation44	3/F	MAC	Immunodeficiency	Femur	PCR	RFP, CLARY	Yes	6 months
Kadota et al^Citation45	63/F	M. abscessus	None	Vertebra	MRI, Culture, DHT, PCR	LVFX, CLARY, AMK	Yes	2 years
Diaz et al^Citation46	15/M	M. goodii	Operation	Femur	MRI, Culture, PCR	TMP/SMX, AMK, CIP	Yes	5 months
Dong et al^Citation47	48/F	M. chelonae	None	Vertebra	MRI, NGS, Biopsy	LVFX, EMB, AMK	No	5 months
Mastroianni et al^Citation48	70/M	M. flavescens	Diabetes	Vertebra	MRI, Biopsy, Culture, PCR	RFP, CIP	No	13 months
Harp et al^Citation49	83/M	M. chelonae	Operation	Metacarpal	MRI, Biopsy, Culture	CLO, AZT	Yes	None
Omori et al^Citation50	74/M	M. abscessus	Immunosuppression	Vertebra	MRI, NAC, WGS	CLARY, AMK, IPM	Yes	None
Garcia et al^Citation51	44/M	MAC	Drug abuser	Vertebra	MRI, Culture, PCR	CLARY, AMK, FOX	No	6 months
Johnson et al^Citation52	47/F	MAC	None	Clavicle, Fibula	X-ray, Culture, Biopsy, PCR	DAP, NAP	Yes	None
Xu X et al^Citation53	43/F	M. avium	None	Clavicle, Skull, Sternum	CT, Culture, PCR	CLARY, EMB, AMX	Yes	5 months
Maupin J et al^Citation54	55/M	M. senegalense	Cataclasis	Tibia, Fibula	X-ray, Culture	IPM, LZD, AZM	Yes	4 months

Abbreviations:NTM, non-tuberculous mycobacteria; HPLC, high-performance liquid chromatography; DHT, DNA hybridization technology; NGS, next-generation sequencing; NAC, nucleic acid chromatography; MAC, Mycobacterium avium complex; FOX, cefoxitin; CIP, ciprofloxacin; CLARY, clarithromycin; IPM, imipenem; LZD, linezolid; MXF, moxifloxacin; AZT, azithromycin; RFP, rifampicin; INH, isoniazid; PZD, pyrazinamide; VAN, vancomycin; AZM, azithromycin; MIN, minocycline; EMB, ethambutol; AMK, amikacin; AMX, amoxicillin; MEM, meropenem; DOX, doxycycline; LVFX, levofloxacin; TMP/SMX, trimethoprim/sulfamethoxazole; CLO, clofazolamide; DAP, daptomycin; NAP, naproxen. *Indicates that the patient died before the bacterial identification results were available.

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