Reactivation of Clostridium tertium bone infection 30 years after the Iran-Iraq war

A 40-year-old-man presented with left knee pain (during night and day) for 3weeks. He has a history of left knee injury from shrapnel contracted in 1987 during the Iran–Iraq war (the patient did not experience cellulitis, loss of function or any other symptom immediately following the injury). At the time of physical examination 30 years later, a small curved scar facing the tibial tuberosity was seen, without fistula, without local signs of inflam- mation and without knee arthritis. X-ray showed bony lysis of the proximal tibia around a foreign metal object (figure 1A). CT scan combined with granulocyte-labelled scintigraphy showed recruit- ments of polymorphonuclear cells within the bone lysis ( figure 1B). Tibiotomy was performed to extract the piece of shrapnel. A gentamicin- impregnated spacer was used to fill the bone cavity, which was later removed. Two of the four bone samples revealed late growth of Clostridium tertium, which was susceptible to penicillin. The patient received amoxicillin and pristinamycin during a course of 12 months. The evolution was favourable (figure 1C).