Abstract: TH-PO172
Successful Treatment of Chronic Osteomyelitis with Avoidance of Amputation During PCSK9-inhibitor Treatment for Cardiovascular Diseases in Patients with Diabetes Mellitus and CKD
Session Information
- Drug Events Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Kyaw, Htet Htet, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Swan, Jr., Alexander Myint, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Aung, Htun M., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Tun, May T., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Mon, Myat Ei, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Swan, Tracy T., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Oo, Yadana, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Oo, Thar Sann, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Thida, Aye M., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Zin, May Thu, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Swan, Alexander M., Rutgers New Jersey Medical School, Newark, New Jersey, United States
Introduction
Management of DM patients with chronic osteomyelitis (OM) of the foot can be challenging. Even with targeted antimicrobial therapy tailored to culture and sensitivity results, due to micro-and-macrovascular ischemia, patients’ conditions usually deteriorate leading to subsequent amputation. We present a case series of 5 patients whose chronic OM recovered during treatment with PCSK9(Proprotein Convertase Subtilisin Kexin type 9) inhibitor to reduce the risk of myocardial infarction, stroke, and coronary revascularization.
Case Description
The patients (age 65-91 years) have a common history of chronic DM-2 (20-35 years) and multiple comorbidities such as coronary artery disease, CKD, CHF, chronic diabetic complications, and peripheral artery disease(PAD). History of DM foot ulcer began as a minor injury, precipitated by DM peripheral neuropathy and atherosclerosis, worsened to cellulitis and subsequent OM. Appropriate antibiotics were used guided by wound culture and sensitivity results without improvement, instead deterioration of infection. Imaging studies of the foot revealed OM. Patients underwent surgical debridement and prolonged antibiotic courses without success, requiring amputation to avoid septicemia and death. However, one month after initiation of PCSK9- inhibitor treatment for cardiovascular co-morbidities, complete wound healings were achieved in those patients, avoiding all planned amputations.
Discussion
Patients with DM have a 10-fold increased risk for lower extremity amputation and almost twice as likely to require re-amputation compared to patients without DM. PCSK9-inhibitor is a human monoclonal IgG preventing PCSK9-mediated LDL-receptor degradation, and allowing LDL-receptor to recycle back to the liver cell surface, thus lowering serum LDL cholesterol. It is speculated that PCSK9-inhibitor may improve circulation, promoting antibiotic penetration into the wound, thus wound healing. We suggest that PCSK9-inhibitor should be used in all patients with PAD and chronic nonhealing wounds as prevention of future amputation. It may also be advantageous to initiate PCSK9-inhibitor in all DM foot ulcer patients during treatment of chronic OM or even before the development of cellulitis or OM.