PVL Staphylococcus aureus osteomyelitis complicating septic arthritis in a UK soldier serving in Iraq.

Musculoskeletal infections caused by Panton-Valentine Leukocidin (PVL) secreting Stapylococcus aureus in children and adolescents have previously been reported. We report the first adult case in a 26 year-old British Army soldier who presented with a S. aureus septic arthritis. He was treated by surgical washout and antibiotics and discharged but was readmitted five months later with an ipsilateral femoral osteomyelitis requiring debridement. The causative S. aureus grown from tissue biopsy taken at time of surgery was found to encode the PVL gene. Whilst there is evidence that soldiers in Iraq have a greater rate of S. aureus colonisation on their skin, the proportion that encode the PVL gene is similar to that observed in the UK. Soldiers are however, subject to the known risk factors that increase vulnerability to PVL secreting S. aureus infection. Military clinicians need to be aware of PVL secreting S. aureus and have a low threshold for requesting specific testing in aggressive musculoskeletal S. aureus infections.