Destructive Mold Osteomyelitis of the Wrist Caused by Scedosporium - A Case Report
Bo C, Conen A, Giacalone M, Marti R, Grobholz R, Seeger H, Klein HJ, Plock JA, Frueh FS (2026) · Journal of Clinical Medicine · n=1
Study Profile
- Design
- single-patient case report (68-year-old kidney-pancreas transplant recipient with Scedosporium chronic wrist osteomyelitis, Kantonsspital Aarau, Switzerland)
- Sample size (n)
- 1
- Intervention
- Multistage hand salvage with osteocutaneous triple-barrel fibula flap reconstruction; postoperative leech therapy for fibula skin island venous congestion; salvage attempt failed due to subsequent multi-resistant Klebsiella and Acinetobacter infection requiring transradial amputation
- Comparator
- Conventional reconstructive options without leech adjunct
- Primary endpoint
- Hand salvage feasibility in immunocompromised host with Scedosporium osteomyelitis
- Primary result
- Initial reconstruction with leech-supported flap survival, but multi-resistant Gram-negative infection caused flap necrosis and ultimate transradial amputation; case highlights balance of limb salvage vs amputation in complex immunocompromised hosts
- Follow-up duration
- Multistage operative course through amputation decision
- PMID
- 42074834
Key Findings
- Chronic wrist Scedosporium osteomyelitis in kidney-pancreas transplant recipient
- Triple-barrel fibula flap reconstruction with leech adjunct
- Multi-resistant Klebsiella and Acinetobacter caused flap loss
- Ultimate transradial amputation despite multistage salvage
- Limb salvage decision-making framework
Limitations
- Single case in extremely immunocompromised host
- Cannot generalize from Scedosporium mold context
- Multi-resistant infection separate from leech use
- Cannot quantify leech contribution to initial flap survival
- Outcomes biased by underlying host immunocompromise
Clinical Implications
Bo 2026 illustrates leech therapy's contribution to ambitious multistage hand salvage in immunocompromised transplant recipients with chronic mold osteomyelitis. For US clinicians under K040187, this case demonstrates that while leech support enables initial flap survival in compromised hosts, fundamentally adverse infectious and immune conditions may still lead to amputation - reinforcing that leech therapy is one tool in complex reconstructive decision-making.
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