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Background   Fusobacterium  species are uncommon causes of osteomyelitis. These organisms are normal flora of the oral cavity. Therefore, they mostly cause osteomyelitis of the head and neck. Hematogenous osteomyelitis at distant sites other than the head and neck has rarely been reported in pediatric or immunocompromised patients. Here, we report the first case of osteomyelitis of a long bone combined with a muscle abscess due to  Fusobacterium nucleatum  in an otherwise healthy adult.    Case presentation  A 59-year-old Korean man was admitted for pain and swelling of the right lower leg, which had been persistent for two weeks. Magnetic resonance imaging showed osteomyelitis of the right fibula with a surrounding muscle abscess of the right lower leg. Incision and drainage was performed, and repetitive tissue cultures grew  F. nucleatum.  In this patient, it was presumed that recurrent periodontitis caused hematogenous seeding of  F. nucleatum  to a distant site leading to osteomyelitis with a muscle abscess. The patient was successfully treated with intravenous ampicillin-sulbactam for three weeks and oral amoxicillin-clavulanate for eight weeks. He also underwent repeated surgical drainage. He has no evidence of recurrence after seven months of follow-up.    Conclusions  Clinicians should be aware that  F. nucleatum  could be the etiologic agent of hematogenous osteomyelitis of a long bone in an immunocompetent patient.

Osteomyelitis of a long bone due to Fusobacterium nucleatum and Actinomyces meyeriin an immunocompetent adult: A case report and literature review