Propionibacterium acnes Osteomyelitis Occurring 23 Years After Craniotomy: Case Report and Review of Literature

BACKGROUND AND IMPORTANCE: Propionibacterium acnes is an uncommon pathogen in delayed surgical site infection, and its indolent course can complicate diagnosis and treatment. We report the longest delay between neurosurgery and P acnes infection reported. CLINICAL PRESENTATION: Asymptomatic postoperative P acnes osteomyelitis and tumor recurrence occurring 23 years after initial craniotomy. Initial presentation was of tumor recurrence only, without signs or symptoms of infection. Calvarial osteomyelitis was unexpectedly discovered intraoperatively. Craniectomy and debridement were performed, and there was prolonged antibiotic therapy. CONCLUSION: The longest delay between neurosurgery and asymptomatic P acnes infection is reported. We review the literature for P acnes infection and discuss biofilm formation and its role in delayed surgical infection.