Introduction
Propionibacterium acnes (P. acnes), also known as Cutibacterium acnes, is a gram-positive anaerobic bacillus that is commonly found near sebum and sweat glands, as well as hair follicles in seborrheic areas of the skin. This commensal bacterium is found in the conjunctiva, external auditory canal, respiratory and gastrointestinal tract (1-4). P. acnes is most commonly associated with acne vulgaris, a chronic skin disorder characterized by clogging and inflammation of pilosebaceous units. In addition to acne vulgaris, P. acnes is associated with several medical conditions such as chronic prostatitis, osteomyelitis, and sarcoidosis (5-7).
P. acnes may be responsible for implant-related and surgical site infections (SSI) associated with the implantation of cardiac, spinal, and orthopedic devices (8). Infection in these settings may be associated with an anaerobic environment, such as a buried implant during surgery, which is conducive to P. acnes development. Additionally, certain P. acnes strains are capable of forming biofilms (9). P. acnes surgical infection has previously been documented following orthopedic shoulder procedures, with a male predominance (10).
We present a case of multiple fractures exacerbated by P. acnes SSI with a dramatic response to oral rifampicin and isotretinoin treatment.