Osteomyelitis caused by Scedosporium apiospermum in an Immunocompetent Patient

Fungal osteomyelitis caused by Scedosporium apiospermum is extremely rare. Osteomyelitis of the lower extremities usually occurs only after the soft tissue is extensively affected by the fungus. The patient described by the present authors had no cutaneous or subcutaneous infection, and no draining sinus was observed. This unusual clinical presentation suggests that deep fungal infection can occur without cutaneous manifestation. The patient’s only injury was a left ankle laceration from a fall 2 years earlier. Diagnosis was by bone biopsy; cultures grew S apiospermum and this was confirmed by molecular analyses. Histopathology sections manifested fungal balls in the ankle bone, which is an unusual setting of the disease, while synovial fluid was negative. Scedosporium is a potent pathogenic agent of serious invasive diseases of bone, and should be considered in the clinical diagnosis of fungal osteomyelitis. J Invasive Fungal Infect 2008;2(3):96‐9.