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.