Chronic tibial osteomyelitis by Cutibacterium (Propionibacterium) acnes with characteristic imaging findings

Background

Osteomyelitis caused by Cutibacterium (Propionibacterium) acnes (C. acnes) is rare, and there are no reports on the use of the Masquelet technique for its treatment.

Case presentation

A 21-year-old male patient visited a local hospital after spraining his left leg. Abnormal linear changes were noted on radiography and magnetic resonance imaging (MRI); however, the leg pain improved over time. Four years later, the patient was referred to our department because he experienced left leg pain again without any particular trigger, and a new linear lesion was found on imaging. Osteomyelitis was suspected. Curettage and filling with vancomycin-loaded bone cement were performed. Intraoperative tissue culture revealed C. acnes. Two months later, the cement was removed, and autologous iliac bone grafting was performed. Bony union was confirmed 5 months after the last surgery.

Conclusion

Osteomyelitis caused by C. acnes can show characteristic imaging findings.