Femur osteomyelitis due to a mixed fungal infection in a previously healthy man

We describe a previously. healthy, 22-year-old man who, after a closed frac ture of the femur and subsequent operation, developed chronic osteomyelitis . Within a few days, infected bone fragments, bone, and wound drainage repe atedly yielded three different filamentous fungi:Aspergillus fumigatus, Asp ergillus flavus! and Chalara ellisii, Histologic examination of the bone re vealed septate hyphae. After sequential necrotomies of the femur and irriga tion-suction drainage with added antimycotic therapy, the infection ceased and the fracture healed. This case is unique in that it is the only known i nstance in which a long bone was affected in an immunocompetent individual, with no evidence of any systemic infection, by a mixed population of two d ifferent Aspergillus spp. and the rare filamentous fungus C. ellisii, Envir onmental factors that could potentiate the infection include blood and edem a fluid resulting from the surgical procedure and the presence of the osteo synthetic plate.