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Ann Thorac Surg 2005;79:1057-1059
© 2005 The Society of Thoracic Surgeons

Case report

Recalcitrant Chest Wall Aspergillus Fumigatus Osteomyelitis After Coronary Artery Bypass Grafting: Successful Radical Surgical and Medical Management

Mohammed M. Elahi, MDa, Amit Mitra, MD, FRCSa, Julia Spears, MDa, James B. McClurken, MD, FACSb,*

a Plastic Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
b Cardiac and Thoracic Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA

Accepted for publication September 11, 2003.

* Address reprint requests to Dr McClurken, Division of Cardiac and Thoracic Surgery, Suite 300, Parkinson Pavillion, 3401 N Broad St, Temple University Hospital, Philadelphia, PA 19140, USA
mcclurjb{at}tuhs.temple.edu

This report describes a 62-year-old male diabetic patient with persistent chest wall osteomyelitis that developed after repeat coronary artery bypass grafting. The chronic infection was localized to the right anterior chest wall and refractory to medical and surgical treatment including long-term antiobiotics, five separate intraoperative debridements, and reconstruction with vascularized omentum over a two-year period at outside institutions. Aggressive surgical debridement with flap reconstruction resulted in definitive management. The organism isolated from multiple intraoperative bone, cartilage, and tissue cultures yielded Aspergillus fumigatus; therapy with itraconazole was utilized for 6 months. Surgical management of osteomyelitis and costochondritis is reviewed accompanied by a literature review on this uncommon cause of chronic chest wall infection.






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Copyright © 2005 by The Society of Thoracic Surgeons.