Delayed Scedosporium apiospermum osteomyelitis following an open ankle fracture in an immunocompetent patient.

Scedosporium apiospermum is a ubiquitous environmental fungus, and several osteomyelitis cases have been reported in recent years. We present the case of a woman in her 70s who sustained a comminuted open ankle fracture, with garden soil contamination of the wound, which was treated according to orthoplastic principles. The patient developed osteomyelitis 6 months postsurgery. Intraoperative samples from the debridement and removal of metalwork showed the growth of S. apiospermum, and the patient was treated with antifungal therapy and surgical debridements. The successful recovery of the patient highlights the possibility of treating fungal osteomyelitis when promptly diagnosed, raising the need for clinical suspicion. The interpretation of the significance of an environmental isolate was aided by a clear recording of not only the mechanism of injury but also the environment where it occurred. Hence, clear documentation and description of open fractures are paramount to patients' care.