Mycoplasma orale is a fastidious oropharyngeal commensal that rarely causes invasive disease. We report a 73-year-old immunocompromised man with destructive, culture-negative wrist osteomyelitis/septic arthritis refractory to multiple antibiotic regimens. Broad-range bacterial polymerase chain reaction at 2 independent reference laboratories concordantly identified M orale. He had staged surgical debridements and received a short course of high-dose daptomycin selected on the basis of in vitro susceptibility data, with resolution and no recurrence. This case underscores early molecular diagnostics and suggests daptomycin, alongside aggressive source control, as a salvage option when conventional Mycoplasma-active regimens fail.
Mielke et al. (Sun,) studied this question.