PMC9253898_01
Demonstration of the sternal wound at initial presentation.
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The abscess was drained, thoroughly irrigated with normal saline until healthy granulation tissue was observed at the base, and packed with iodoform packing strips that were exchanged on a daily basis (Fig. 1).
Computed tomography of the chest with contrast showing inflammatory changes surrounding the sternum with non-union of sternal components (arrow).
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An initial computed tomography (CT) of the chest with contrast showed inflammatory changes surrounding the sternum with non-union of sternal components yet with no obvious abscess (Fig. 2).
Erythema around the sternal wound edges with surrounding blisters (arrow) one week after completion of intravenous ceftriaxone.
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However, one week following completion of the ceftriaxone regimen, he developed recurrent anterior chest wall pain and erythema around the wound edges with surrounding blisters (Fig. 3).
Magnetic resonance imaging of the sternum with contrast showing chronic sternal non-union with reactive bone edema (white arrow) with a small non-enhancing fluid channel (red arrow) adjacent to the area of osteomyelitis suggesting a small fistulous tract extending to the skin surface.
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Also visualized was a small non-enhancing fluid channel adjacent to the area of osteomyelitis that suggested the presence of a small fistulous tract extending to the skin surface (Fig. 4).
Gram stain showing rare beaded Gram-positive rods consistent with the appearance of an aerobic actinomycete (arrow).
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Gordonia bronchialis was subsequently identified in both tissue and bone samples. Gram stain revealed the presence of rare, beaded Gram-positive rods consistent with the appearance of an aerobic actinomycete (Fig. 5).