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Septic Prepatellar Bursitis Caused by Traumatic Inoculation of Nocardia NovaCase Report and Literature Review
Walter A. Anazonwu, BS1; Lisa Goldstein, MD2; John R. Lonks, MD2; Lee E. Rubin, MD3
1 Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02906. E-mail address: walter_anazonwu@brown.edu
2 Department of Pathology, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906. E-mail address for L. Goldstein: lgoldstein@lifespan.org. E-mail address for J.R. Lonks: John_Lonks@brown.edu
3 University Orthopedics, Inc., 2 Dudley Street, Suite 200, Providence, RI 02905. E-mail address: lrubin@universityorthopedics.com
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Investigation performed at the Warren Alpert Medical School of Brown University, Providence, Rhode Island

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 May 08;3(2):e45 1-3. doi: 10.2106/JBJS.CC.L.00307
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The Nocardia species belongs to the Actinomycetaceae family, and it typically appears as delicate, branching, and filamentous gram-positive rods. Because of the uncommon nature of Nocardia infections, very few cases of musculoskeletal infections caused by the Nocardia species have been reported1. One case reported Nocardia nova infection of a total hip prosthesis in a patient who had a severe case of systemic lupus erythematosus2, and another report described cutaneous nocardiosis that led to sepsis following a total knee replacement1. In this paper, we report an unusual case of septic prepatellar bursitis caused by Nocardia nova following a traumatic injury. Since the mechanism of injury in this case report is so universally common, the importance of this report is twofold: first, to alert orthopaedic surgeons to include Nocardia species on a differential list of bacterial pathogens, and second, to suggest consideration that culture results be followed for an extended period to assist in the identification of atypical pathogens when diagnosing musculoskeletal infections. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.
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