Medical Management of Mixed Nocardial and Unidentified Fungal Osteomyelitis in a Kemp's Ridley Sea Turtle, Lepidochelys kempii
J Herpe Med Surg 12[3]:21-26 Fall'02 Case Report AT - Roundtable 22 Refs

A hypothermic-stunned juvenile Kemp's Ridley sea turtle, Lepidochelys kempii, developed right carpal swelling early in rehabilitation. Osteomyelitis was detected initially as a small radiolucency of the proximal aspect of the metacarpal of digit 1, and spread over the course of several weeks nearly to obliterate the distal carpal row and affect the ulnar and pisiform carpals and metacarpals II and III. Unbranching unpigmented septate fungal hyphae were observed cytologically from a fine needle aspirate, however fungal culture was negative. A Nocardia sp. was cultured from the fine needle aspirate. Although surgical debridement was strongly considered, concerns over postoperative management of a submerged open contaminated wound at a mobile joint led to a decision to attempt medical management alone. Prolonged combined treatment with fluconazole (one year) and azithromycin (162 d) resulted in a functional carpal joint with substantial remineralization of the carpal and metacarpal bones, normal flipper contour, full range of motion and apparently normal swimming. Anti-nocardial treatment preceding azithromycin, first with sulfadimethoxine, then with oxytetracycline, appeared to reduce swelling but were associated with suspected adverse reactions. Husbandry conditions with a good plane of nutrition, excellent water quality and minimal disturbance undoubtedly contributed to the successful outcome. The sea turtle was released 20 m after stranding. [Abstract]