TITLE:
Proteus mirabilis Ischial Osteomyelitis with Sinus Tract Treated by Live Leech Therapy: A Case Report and Literature Review
AUTHORS:
Yangfei Wei, Dan Zhang, Ming Shi, Song Li, Junjun Cao
KEYWORDS:
Hirudo Medicinalis, Proteus mirabilis, Osteomyelitis, Wound Healing
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.3,
March
5,
2026
ABSTRACT: Background: Chronic ischial osteomyelitis, particularly when complicated by sinus tract formation, presents a significant therapeutic challenge. While systemic antibiotic therapy remains a cornerstone of treatment, its efficacy is often limited in resolving established sinus tracts. This case report explores the therapeutic potential of living leech therapy in this challenging clinical scenario, providing a detailed account of its application and reviewing the supporting evidence from the literature. Reporting this case may provide clinicians with new ideas for the treatment of chronic ischial osteomyelitis. Case Presentation: A 41-year-old unemployed Chinese male was admitted to the hospital due to recurrent perianal exudation for 3 years and a diagnosis of ischial osteomyelitis for 1 year. The patient had a past history of “paraplegia” and no drug allergies. Laboratory examinations showed that the patient’s erythrocyte sedimentation rate and C-reactive protein were significantly increased, and CT and magnetic resonance imaging showed the presence of buttock sinus tract, and histopathology showed tissue necrosis in the lesion of buttock sinus tract. After anti-infection, surgical debridement, and living leech therapy, the buttock sinus tract of the patient was basically healed. Follow-up demonstrated the buttock sinus tract of the patient was completely healed without fluid exudation. Conclusion: This case highlights the potential of Live Leech Therapy combined with antibacterial agents for treating chronic ischial osteomyelitis with refractory sinus tracts, demonstrating satisfactory therapeutic outcomes. While Live Leech Therapy is characterized by its ease of use, low cost, and encouraging initial efficacy, and possesses promising biochemical effects, the underlying mechanisms require further elucidation and potential risks such as infection or allergy must be carefully considered. Further research is warranted to explore the role of Live Leech Therapy in managing refractory osteomyelitis and other complex wound conditions.