Peritonitis due to Streptococcus viridans in patients receiving continuous ambulatory peritoneal dialysis.

Air in the bones: multifocal anaerobic osteomyelitis associated with oat cell carcinoma Under 2",, of cases of osteomyelitis are due to anaerobes.'We report a case of multifocal anaerobic osteomyelitis complicating widespread bone metastases from an oat cell carcinoma of the lung. Case reportA 60 year old white man was admitted with low back pain, 10 kg weight loss, and bilateral leg oedema.He was a heavy smoker and drinker.He was afebrile with signs of chronic alcoholism and bilateral leg oedema.Oral hygiene was poor.His liver was firm and enlarged.His lumbar vertebrae and pelvic bones were painful on percussion.White cell count was 22-3x 109/ (68°,0 segmented).A chest x ray film showed a 2 cm nodule.Computed tomography showed bilateral abscesses along the psoas and the iliac muscles and gas in the pelvic bones, T5, T6, LI, L4, L5, and the spinal canal (figure).Areas of osteolysis as well as gas were detected on x ray films Computed tomogram of L1, showing gas bubbles wvithin vertebral body, spinal canal, and psoas muscles (vertical arrows); psoas abscesses are seen along lateral aspect of vertebral body (horizontal arrow).of the thoracic and lumbar spine and the pelvic bones.Metastases were seen in the liver.Bone marrow aspirate from the iliac crest was foul smelling, and Gram staining showed abundant Gram positive cocci.The bone marrow and eight blood cultures were positive for Peptococcuts indolicts.Intravenous penicillin wvas started.He died on the 34th hospital day.