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Tan WC, Lau SCX, Lim YT. Pumice stone sign: Emphysematous osteomyelitis in diabetic ketoacidosis. Int J Infect Dis 2024; 143:106977. [PMID: 38401780 DOI: 10.1016/j.ijid.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/16/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Wei Chuan Tan
- Department of Diagnostic Imaging, National University Hospital, Singapore.
| | | | - Yi Ting Lim
- Department of Diagnostic Imaging, National University Hospital, Singapore
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2
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Saha D, Tai R, Kapare V, Joshi G. Multifocal emphysematous osteomyelitis, a do not miss diagnosis for the emergency radiologist: a case report with literature review. Emerg Radiol 2024; 31:285-288. [PMID: 38267799 DOI: 10.1007/s10140-024-02203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.
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Affiliation(s)
- Debajyoti Saha
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA.
| | - Ryan Tai
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
| | - Vaishali Kapare
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
| | - Ganesh Joshi
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
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Khan A, Zaidi FN, Anwar M, Ahmad M, Rehman AU. Emphysematous Osteomyelitis Involving the Spine, a Case of a Rare Form of Osteomyelitis. Cureus 2023; 15:e41208. [PMID: 37525769 PMCID: PMC10387325 DOI: 10.7759/cureus.41208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
Gas-forming bacteria like Staphylococcus aureus (SA), along with the worrisome infections it causes, can lead to a fairly overlooked but lethal complication, called emphysematous osteomyelitis (EO). It is a condition characterized by the infection of bones complicated by the presence of gas-forming organisms. Here, we present a 50-year-old woman with insulin-dependent type 2 diabetes, who presented with cough, high-grade fevers, rigors, chills, and back pain from the last seven days. Laboratory tests revealed elevated inflammatory markers and a hyperosmolar hyperglycemic state. Sputum smear and blood cultures both reported the presence of SA. The presence of air foci in the third lumbar spine vertebra (L3) and the surrounding soft tissue was confirmed by computed tomography (CT). The posterior elements were spared, and the vertebral height and intervertebral disc were preserved. The extent of the damage done to the bone was analyzed by magnetic resonance imaging (MRI). The findings showed transverse relaxation time (T2) and short tau inversion recovery (STIR) sequences, consistent with the diagnosis of EO. She was put on strict glucose monitoring and a combination of intravenous antibiotics for three weeks followed by two weeks of oral therapy. Her symptoms improved with conservative management and reported no recurrence of any symptom of such type ever since.
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Affiliation(s)
- Adil Khan
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Farah N Zaidi
- Medicine, Queen Elizabeth Hospital, King's Lynn, GBR
| | - Maryem Anwar
- Family Medicine, National Health Service (NHS), Slough, GBR
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Moon TJ, Ina J, Raji Y, Padubidri A, Sontich J. Emphysematous Osteomyelitis of the Pubis Associated With Necrotizing Soft Tissue Infection of the Thigh. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00008. [PMID: 37141508 PMCID: PMC10155894 DOI: 10.5435/jaaosglobal-d-21-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
Emphysematous osteomyelitis (EO) is a rare condition identified through the presence of intraosseous gas. It is frequently fatal even with prompt recognition and management. We report a case of EO presenting with a necrotizing soft tissue infection of the thigh in the setting of prior pelvic radiation. The purpose of this study was to highlight the unusual association between EO and necrotizing soft tissue infection.
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Affiliation(s)
- Tyler J Moon
- From the Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University
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Waelti SL, Wildermuth S, Willems EP, Fischer T, Dietrich TJ, Leschka S, Matissek C, Krebs T, Markart S. Prospective Evaluation of Magnetic Resonance Imaging Features of Magnesium-Based Alloy Screw Resorption in Pediatric Fractures. J Clin Med 2023; 12:jcm12083016. [PMID: 37109351 PMCID: PMC10141748 DOI: 10.3390/jcm12083016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The resorption of magnesium-based alloy bioabsorbable screws results in the release of hydrogen gas, which can mimic infection and enter the growth plate. The screw itself and the released gas may also affect image quality. OBJECTIVE The evaluation of magnetic resonance imaging (MRI) findings during the most active phase of screw resorption is the objective, with particular focus on the growth plate and to assess for the presence of metal-induced artifacts. MATERIAL AND METHODS In total, 30 prospectively acquired MRIs from 17 pediatric patients with fractures treated with magnesium screws were assessed for the presence and distribution of intraosseous, extraosseous, and intra-articular gas; gas within the growth plate; osteolysis along the screw; joint effusion; bone marrow edema; periosteal reaction; soft tissue edema; and metal-induced artifacts. RESULTS Gas locules were found in the bone and soft tissues in 100% of the examinations, intra-articular in 40%, and in 37% of unfused growth plates. Osteolysis and the periosteal reaction were present in 87%, bone marrow edema in 100%, soft tissue edema in 100%, and joint effusion in 50% of examinations. Pile-up artifacts were present in 100%, and geometric distortion in 0% of examinations. Fat suppression was not significantly impaired in any examination. CONCLUSIONS Gas and edema in the bone and soft tissues are normal findings during the resorption of magnesium screws and should not be misinterpreted as infection. Gas can also be detected within growth plates. MRI examinations can be performed without metal artifact reduction sequences. Standard fat suppression techniques are not significantly affected.
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Affiliation(s)
- Stephan L Waelti
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Simon Wildermuth
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Erik P Willems
- Clinical Trials Unit, Biostatistics, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Tobias J Dietrich
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Sebastian Leschka
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Christoph Matissek
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
| | - Thomas Krebs
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
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Bhattarai V, Acharya K, Kuikel S, Mahat S, Agarwal S, Ghimire R, Poudel ASK. Radiologic finding of intraosseous gas: A rare case of emphysematous osteomyelitis of the foot. Radiol Case Rep 2023; 18:643-646. [DOI: 10.1016/j.radcr.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 12/02/2022] Open
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Ghosen J, Lucasti C, Daoust S. Parvimonas micra Causing Emphysematous Osteomyelitis: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00007. [PMID: 36240293 DOI: 10.2106/jbjs.cc.22.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/10/2022] [Indexed: 11/06/2022]
Abstract
CASE We present an interesting case of femoral emphysematous osteomyelitis (EO) in a 67-year-old patient with the offending pathogen to be Parvimonas micra. Two knee arthrotomies with lateral thigh exploration were performed to debride and irrigate the bone and compartments. Although the patient initially improved, definitive treatment with an antibiotic intramedullary rod was necessary and resulted in complete resolution. CONCLUSION We present the first case of EO secondary to P. micra described in the literature and recommend aggressive surgical management for complete resolution and preserved functional outcome.
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Affiliation(s)
- James Ghosen
- University at Buffalo Jacobs School of Medicine, Buffalo, New York
| | | | - Susan Daoust
- UBMD Orthopaedics and Sports Medicine, Buffalo, New York
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Lee D, Mohile N, Rakoczy K, Gjolaj JP. Emphysematous osteomyelitis of the spine: a case report and case based review of the literature. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:362-376. [PMID: 36285094 PMCID: PMC9547692 DOI: 10.21037/jss-22-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND/OBJECTIVE Emphysematous osteomyelitis (EO) of the spine is an uncommon type of osteomyelitis characterized by intraosseous gas-formation in the vertebrae. The objective of this report is to present a rare case of spine EO in a patient with emphysematous cystitis. A case-based review of the literature on spinal EO was also performed as an update to the relevant literature of this rare infection. CASE DESCRIPTION/METHODS A 55-year-old female with diabetes mellitus and peripheral vascular disease (PVD) presented to our institution with recurrent falls, fatigue, and low back pain. Computed tomography (CT) and magnetic resonance imaging (MRI) scans confirmed emphysematous cystitis and EO at L4. Given the diffuse involvement, surgical intervention was deferred for IV antibiotic therapy. A case-based review was also conducted by searching the SCOPUS and PubMed databases for the following terms: "emphysematous osteomyelitis", "gas", and "spine". Only publications in English were included in this review. KEY CONTENT/FINDINGS Urine/blood cultures identified Klebsiella pneumoniae. After initial improvement with six weeks of broad-spectrum antibiotics, the patient re-presented with recurrent fevers and fatigue. Despite maximal medical therapy, the patient expired 2 months later due to multi-organ system failure. Including the present report, only 29 cases of spine EO have been described in the literature. Patients almost consistently presented with fever, elevated inflammatory markers, and localized pain. Most cases of spinal EO (89.7%) were monomicrobial. Escherichia coli (37.9%) and Klebsiella pneumoniae (27.6%) were the most causative organisms identified. Medical treatment universally consisted of broad-spectrum IV antibiotics prior to tailoring. Debridement and decompression, with or without fusion, were the main operative procedures performed for spine EO. Outcomes following spinal EO are varied with a 44.4% mortality rate. CONCLUSIONS We present a case of EO of the spine and concomitant emphysematous cystitis with Klebsiella pneumoniae and a case-based review of the literature. Appropriate work up for this rare infection should include inflammatory markers, cultures, and CT/MRI imaging. Treatment consists of IV antibiotics with anaerobic and gram-negative coverage. However, treatment guidelines and operative indications for spinal emphysematous osteomyelitis remain unclear.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
| | - Neil Mohile
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
| | - Kyla Rakoczy
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joseph P. Gjolaj
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
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Iftikhar S, Iftikhar S, Ijaz N, Akhtar M, Gul H. A Rare Facultative Anaerobe Causing Emphysematous Osteomyelitis of the Pubic Bone. Cureus 2022; 14:e26575. [PMID: 35936166 PMCID: PMC9351716 DOI: 10.7759/cureus.26575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
Emphysematous osteomyelitis is an uncommon and fatal disease that can only be confirmed with a contrast-enhanced CT scan showing characteristic features of air locules within the bone. It usually occurs in the setting of existing comorbidities and suppressed immune system resulting in widespread bacteremia which may be mono or poly-microbial. Presented here is a case of this disease caused by an unusual anaerobe affecting the pubic bone. This case emphasizes the importance of early imaging as it is crucial for the diagnosis and can facilitate early aggressive management. Moreover, it highlights the importance of early intravenous antibiotics and surgical intervention, which can be life-saving and result in a better outcome in the future.
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Affiliation(s)
- Michael J Litt
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Mary W Montgomery
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Kirstin M Small
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Amy L Miller
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Joseph Loscalzo
- From the Department of Medicine, Brigham and Women's Hospital, Boston
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Sachdev IS, Tomer N, Bethapudi S, Priya S, Atwal S. A Rare Case of Emphysematous Osteomyelitis of Femur in an Intravenous Drug User. Cureus 2021; 13:e16782. [PMID: 34513389 PMCID: PMC8405401 DOI: 10.7759/cureus.16782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/05/2022] Open
Abstract
Emphysematous osteomyelitis (EO) is a rare condition characterized by the appearance of gas locules within the bone on imaging, usually as a result of anaerobic bacterial infection. We present the case of a 46-year-old known intravenous (IV) drug user who was admitted to the emergency department with intractable pain in the right groin. He was febrile with elevated white cell count and C-reactive protein. He underwent an X-ray and CT of the pelvis which demonstrated intraosseous gas in the proximal right femur. A diagnosis of EO was made radiologically, allowing for prompt antibiotic treatment and a plan for surgical debridement. There are only a handful of published cases of EO in the literature, only one of which has described IV drug use as the underlying factor.
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Affiliation(s)
| | - Neeru Tomer
- Radiology, County Durham and Darlington NHS Foundation Trust, Darlington, GBR
| | - Sarath Bethapudi
- Radiology, County Durham and Darlington NHS Foundation Trust, Darlington, GBR
| | - Sarv Priya
- Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Swapndeep Atwal
- Radiology, County Durham and Darlington NHS Foundation Trust, Darlington, GBR
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Kim HJ, Ryu JH, Park HY, Kim SI, Chang DG. Rapidly progressive gas-forming infection involving the spine as a life-threatening fatal condition : a case report. BMC Musculoskelet Disord 2021; 22:696. [PMID: 34399703 PMCID: PMC8365979 DOI: 10.1186/s12891-021-04589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gas forming infection of the spine is a consequence of vertebral osteomyelitis, necrotizing fasciitis, or a gas-forming epidural abscess, which is very rare and fatal conditions. This is the rare case of necrotizing fasciitis that rapidly progressed from the lumbar area to upper thoracic area. CASE PRESENTATION A 58-year-old male complained of lower back pain with fever and chills. The patient had a history of uncontrolled diabetes mellitus without diabetic medication over the previous 3 months, and he had received several local injections around the lumbar area. Laboratory data revealed white blood cell count of 19,710 /mm3, erythrocyte sedimentation of 40 mm/h, and C-reactive protein of 30.7 mg/L. Radiological findings revealed a small amount of air bubbles in the paraspinal area and lumbar epidural spaces. The patient refused emergency surgery and was discharged from the hospital. The patient re-visited the emergency department two days after discharge complaining of more severe back pain with persistent fever, and his vital signs had deteriorated, with low blood pressure and tachycardia. K. pneumoniae was isolated in cultures from ultrasound-guided aspirates and peripheral blood. The follow-up radiographs revealed aggressive dissemination of innumerable air bubbles from the lumbar area to the T5 level. The patient underwent emergent decompressive laminectomy and debridement of infected paravertebral fascia and musculature. Despite intensive care for deteriorated vital signs and his back wound, the patient died on postoperative day 3 due to multi-organ failure. CONCLUSIONS Necrotizing fasciitis involving the spine is a very rare disease with life-threatening conditions, rapid progression, and a high mortality rate. Therefore, prompt surgical treatment with a high index of suspicion is imperative to prevent potentially fatal conditions in similar extremely rare cases.
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Affiliation(s)
- Hong Jin Kim
- Spine Center and Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, 1342, Dongil-Ro, Nowon-Gu, 01757, Seoul, Republic of Korea
| | - Ji-Hyun Ryu
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Youl Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Il Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gune Chang
- Spine Center and Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, 1342, Dongil-Ro, Nowon-Gu, 01757, Seoul, Republic of Korea.
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Khanduri S, Singh M, Goyal A, Singh S. Emphysematous osteomyelitis: Report of two cases and review of literature. Indian J Radiol Imaging 2021; 28:78-80. [PMID: 29692532 PMCID: PMC5894325 DOI: 10.4103/ijri.ijri_28_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Emphysematous osteomyelitis is a rare condition characterized by the presence of intraosseous gas. A prompt diagnosis is required for this disease to expedite management as it is a potentially fatal condition. Many comorbidities, such as malignancy, diabetes mellitus, alcohol abuse, Crohn's disease, and other etiologies causing immunosuppression, predispose to this condition. The causative organisms are generally anaerobes or members of Enterobacteriaceae family; however, the infection can be mono or polymicrobial. We report two cases affected with emphysematous osteomyelitis due to varied underlying comorbidities. The purpose of this study is to (a) emphasize the importance of computed tomography in diagnosing emphysematous osteomyelitis and (b) to highlight an unusual location of this rare pathology.
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Affiliation(s)
- Sachin Khanduri
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Meenu Singh
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Aakshit Goyal
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Simran Singh
- Department of Radio-diagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Activity of Liquid and Volatile Fractions of Essential Oils against Biofilm Formed by Selected Reference Strains on Polystyrene and Hydroxyapatite Surfaces. Pathogens 2021; 10:pathogens10050515. [PMID: 33922823 PMCID: PMC8145098 DOI: 10.3390/pathogens10050515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
Biofilms are surface-attached, structured microbial communities displaying higher tolerance to antimicrobial agents in comparison to planktonic cells. An estimated 80% of all infections are thought to be biofilm-related. The drying pipeline of new antibiotics efficient against biofilm-forming pathogens urges the search for alternative routes of treatment. Essential Oils (EOs), extracted from medicinally important plants, are a reservoir of bioactive compounds that may serve as a foothold in investigating novel antibiofilm compounds. The aim of this study was to compare antimicrobial activity of liquid and volatile fractions of tested EOs against biofilm-forming pathogens using different techniques. In this research, we tested five EOs, extracted from Syzygium aromaticum L., Boswelia serrata Roxb., Juniperus virginiana L., Pelargonium graveolens L. and Melaleuca alternifolia Cheel., against planktonic and biofilm forms of five selected reference strains, namely Staphylococcus aureus, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans. To obtain cohesive results, we applied four various methodological approaches: to assess the activity of the liquid fraction of EOs, disc diffusion and the microdilution method were applied; to test EOs’ volatile fraction, the AntiBioVol assay and modified Antibiofilm Dressing Activity Measurement (A.D.A.M.) were used. The molecular composition and dynamics of antimicrobial substances released from specific EOs was measured using Gas Chromatography–Mass Spectrometry (GC-MS). The antimicrobial potency of EO’s volatile fraction against biofilm formed by tested strains differed from that of the liquid fraction and was related to the molecular weight of volatile compounds. The liquid fraction of CW-EO and volatile fraction of F-EO acted in the strongest manner against biofilm of C. albicans. The addition of 0.5% Tween 20 to liquid phase, enhanced activity of G-EO against E. coli and K. pneumoniae biofilm. EO activity depended on the microbial species it was applied against and the chosen assessment methodology. While all tested EOs have shown a certain level of antimicrobial and antibiofilm effect, our results indicate that the choice of EO to be applied against a specific biofilm-forming pathogen requires careful consideration with regard to the above-listed aspects. Nevertheless, the results presented in this research contribute to the growing body of evidence indicating the beneficial effects of EOs, which may be applied to fight biofilm-forming pathogens.
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Chamsi Basha A, Khalifa MA, Albadr F, Kaid J, Alsakkaf H. Hip bone osteonecrosis with intraosseous pneumatosis after abdominal aortic aneurysm repair: a case of emphysematous osteomyelitis. BJR Case Rep 2021; 7:20200138. [PMID: 33614123 PMCID: PMC7869127 DOI: 10.1259/bjrcr.20200138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 11/09/2022] Open
Abstract
Intraosseous pneumatosis is a rare and often fatal condition characterised by air accumulation in the bone that may be brought about by infection, trauma (surgical or otherwise), degenerative disease or neoplastic processes. Here, we present a case of pelvic emphysematous osteomyelitis following repair of an infected abdominal aortic aneurysm. A 56-year-old Saudi male, known to have diabetes and hypertension, presented to the emergency department complaining of intermittent abdominal pain over the right lower quadrant. The patient was later diagnosed intraoperatively with an infected abdominal aortic aneurysm and treated appropriately. During multiple follow-up imaging studies, the patient was noted to have multiple intra-abdominal fluid collections, as well as intraosseous pneumatosis in the pelvis and right femur. 3 months later, intervention was again required due to patient deterioration and possible aortic graft leakage. Graft abscess was diagnosed and managed. We present a case of an infected abdominal aortic aneurysm that eventually led to emphysematous osteomyelitis of the pelvis. This case report sheds light on intraosseous pneumatosis and emphysematous osteomyelitis, which is characterised by the former, in addition to signs of an underlying infection or abscess formation.
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Affiliation(s)
- Amjad Chamsi Basha
- College of Medicine, Sulaiman AlRajhi University PO Box 777, Al Bukairiyah, Saudi Arabia
| | | | - Fahad Albadr
- Department of Radiology, College of Medicine, King Saud University PO Box 145111, Riyadh, Saudi Arabia
| | - Jamal Kaid
- King Saud University Medical City, Department of Radiology, PO Box 2925, Riyadh, Saudi Arabia
| | - Hussein Alsakkaf
- King Saud University Medical City, Department of Radiology, PO Box 2925, Riyadh, Saudi Arabia
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Park SE, Yoo HJ, Hong SH, Choi JY, Chae HD. Atypical infectious spondylitis with reduced bone marrow enhancement: "black vertebra sign". Acta Radiol 2020; 61:1553-1561. [PMID: 32088965 DOI: 10.1177/0284185120907228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A few patients suspected of having infectious spondylitis exhibited a reduced enhancement pattern on postcontrast T1-weighted (T1W) magnetic resonance imaging (MRI). PURPOSE To investigate the characteristics of infectious spondylitis patients who exhibited reduced vertebral enhancement. MATERIAL AND METHODS From January 2010 to November 2017, 456 patients with findings suspicious for infectious spondylitis on 706 postcontrast T1W imaging were retrospectively evaluated. When an affected vertebra exhibited markedly reduced enhancement compared to normal bone marrow (BM), the vertebra was termed a "black vertebra." MRI and computed tomography (CT) imaging findings within two-week intervals and the patients' clinical characteristics were reviewed. RESULTS Ten patients (5 men, 5 women; mean age 66.4 years) whose MRI scans revealed the black vertebra sign were included. Among the 10 patients with black vertebrae, six patients exhibited signal voids in or around the affected vertebral bodies on T2-weighted (T2W) images. Eight patients showed air bubbles on CT images, suggestive of emphysematous infection. However, the typical image findings of infectious spondylitis were uncommon, namely, low BM signal intensity (SI) on T1W images (n=1) and intradiscal fluid-equivalent SI on T2W images (n=5) at an early stage. On follow-up MRI (average interval 7.2 weeks from initial MRI), available for five patients, marked progression of infection was evidenced by increased numbers of affected segments (n=3), low T1 SIs of the affected vertebrae (n=5), and increased contrast enhancement (n=3). Five patients underwent surgery to treat infections not controlled by antibiotics. CONCLUSION A black vertebra sign on postcontrast T1W imaging seems to reflect an early emphysematous infection.
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Affiliation(s)
- Sung Eun Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Ja-Young Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Dong Chae
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
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17
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Gas forming infection of the spine: a systematic and narrative review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1708-1720. [PMID: 33108532 DOI: 10.1007/s00586-020-06646-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/02/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Gas forming infection (GFI) of the spine is a rapidly progressive and potentially life-threatening infection. It can be a consequence of aetiologies such as Emphysematous Osteomyelitis (EOM), Necrotizing Fasciitis (NF), and Gas-containing Spinal Epidural Abscess (Gas-containing SEA). This review aims to summarize the characteristics of these subtypes of GFI, describing their aetiology, diagnosis, management, and prognosis. METHODS PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on gas forming infections of the spine or a known subtype. Cases of post-operative and iatrogenic spinal infection were excluded. RESULTS The literature review revealed 35 studies reporting on 28 cases of EOM, three cases of NF involving the spine and seven cases of Gas-containing SEA. Thirty studies reporting on 32 cases of GFI were available for data analysis. The mean age of the patients was 60.9 years and a concomitant diagnosis of diabetes mellitus was reported in 57.5% of patients infected. Fever and back pain were the most common presenting symptoms. The lumbar spine was the most commonly affected spinal segment. Mortality from EOM, NF and Gas-containing SEA were 34.8, 100 and 28.5%, respectively. DISCUSSION Gas forming infection of the spine is a rare condition with an extremely poor prognosis, requiring early and aggressive surgical treatment. A multi-disciplinary approach is necessary for management. Nonetheless, even in cases of early recognition and optimal management, multisystem failure may still occur, and mortality rates remain high due to the aggressive nature of this infection. LEVEL OF EVIDENCE Systematic review of level IV studies.
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18
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Extensive multifocal emphysematous osteomyelitis: fatal outcome in a patient with psychiatric history. Skeletal Radiol 2020; 49:1487-1493. [PMID: 32447471 DOI: 10.1007/s00256-020-03470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
Emphysematous osteomyelitis is a rare entity with potentially devastating consequences, even after prompt and aggressive intervention. It is characterized by intraosseous gas and may be complicated by adjacent abscess formation. There are a handful of previously reported cases of emphysematous osteomyelitis, but none to the degree as reported here. Specifically, we report an extremely rare case of extensive multifocal emphysematous osteomyelitis involving both the axial and appendicular skeleton in a 20-year-old woman.
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19
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Spontaneous emphysematous osteomyelitis of the spine: A case report. Radiol Case Rep 2020; 15:1552-1554. [PMID: 34168712 PMCID: PMC8206567 DOI: 10.1016/j.radcr.2020.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/24/2022] Open
Abstract
Spontaneous emphysematous osteomyelitis of the spine is a very rare but severe condition caused by gas-forming microorganisms. We present the case of a 41-year-old obese male patient presenting at the Emergency Department with diabetic ketoacidosis, fever, and difficulty in walking. computed tomography and magnetic resonance imaging of the spine revealed bone marrow edema and intraosseous gas collections at the level of the fourth and fifth lumbar metameres, suggesting an osteomyelitis sustained by gas-forming microorganisms, which was then confirmed by the isolation of Klebsiella pneumonia in blood culture. Imaging plays a central role for the diagnosis of emphysematous osteomyelitis: the presence of multiple intraosseous gas collections of variable size, especially in patients with specific risk factors, is highly suggestive of an infection caused by gas-forming pathogens. Being familiar with this peculiar neuroradiological appearance is essential to ensure an early diagnosis and a timely antimicrobial therapy, which can considerably ameliorate the prognosis.
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20
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Leturia Etxeberria M, Biurrun Mancisidor MC, Ugarte Nuño A, Arenaza Choperena G, Mendoza Alonso M, Esnaola Albizu M, Serdio Mier A, Gredilla Sáenz M, Gomez Usabiaga V. Imaging Assessment of Ectopic Gas Collections. Radiographics 2020; 40:1318-1338. [DOI: 10.1148/rg.2020200028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Leturia Etxeberria
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Maria Carmen Biurrun Mancisidor
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Ane Ugarte Nuño
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Gorka Arenaza Choperena
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Miguel Mendoza Alonso
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Maite Esnaola Albizu
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Alberto Serdio Mier
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - María Gredilla Sáenz
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Virginia Gomez Usabiaga
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
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21
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Elshikh A, Gowda N, Glass L, Maximos RB. Emphysematous osteomyelitis of the clavicle: a pleural process? BMJ Case Rep 2020; 13:13/7/e235764. [PMID: 32723778 DOI: 10.1136/bcr-2020-235764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Emphysematous osteomyelitis (EO) is a rare infection associated with intraosseous gas. EO is an often fatal disease with an estimated 34% mortality. We present a case of a 63-year-old man with sternoclavicular EO with pleural involvement and significant subcutaneous emphysema diagnosed by CT. Extension of intraosseous gas into the pleural cavity is an extremely interesting presentation that has not been previously reported. The patient underwent a multidisciplinary treatment approach with surgical debridement and an extended antibiotic course. Intraoperative cultures of the pectoralis muscle and bone biopsy grew pan-sensitive Escherichia coli Prompt recognition and treatment are paramount to avoid a potentially fatal outcome. A review of the literature of the previous 46 cases of EO is presented for associated risk factors, the role of surgical management and antibiotic therapy.
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Affiliation(s)
- Amira Elshikh
- Internal Medicine, George Washington University, Washington, District of Columbia, USA
| | - Niraj Gowda
- Internal Medicine, George Washington University, Washington, District of Columbia, USA
| | - Lisa Glass
- Division of Pulmonary, Critical Care and Sleep Disorders Medicine, Department of Medicine, George Washington University, Washington, District of Columbia, USA
| | - Robert B Maximos
- Pulmonary, Critical Care and Sleep Disorders Medicine, The George Washington University Hospital, Washington, District of Columbia, USA.,Pulmonary and Critical Care, Department of Veterans Affairs, Washington, District of Columbia, USA
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22
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Sung S, Lee BH, Kim JH, Park Y, Ha JW, Moon SH, Lee HM, Kwon JW. Emphysematous osteomyelitis of the spine: A rare case report. Medicine (Baltimore) 2020; 99:e21113. [PMID: 32664134 PMCID: PMC7360287 DOI: 10.1097/md.0000000000021113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Emphysematous osteomyelitis is a rare disease caused by gas-forming bacteria. But only 45 cases have been reported in the literature since then. PATIENT CONCERNS A 72-year-old female presented to our hospital with severe lower back pain that aggravated 4 days ago. DIAGNOSES Computed tomography (CT) revealed intraosseous mottled air in the T12 and L1 vertebral bodies and epidural space. The enhanced T1 and T2 magnetic resonance imaging scans showed heterogeneous signal intensity of vertebral bodies, suggestive of emphysematous osteomyelitis. INTERVENTIONS Surgery was performed to identify culture strains and to remove emphysematous lesions of the vertebral body using extensive transpedicular irrigation. OUTCOMES Escherichia coli (E coli) was identified in the surgical specimen, and intravenous antibiotic therapy was continued with cefotaxime. The patient had a significant decrease in lower back pain after the surgery and the final CT scan before discharge revealed significantly decreased air at T12 and L1 vertebral bodies and no air density in the epidural space. LESSONS We present a patient diagnosed with emphysematous osteomyelitis in vertebral bodies caused by E coli and successfully treated with surgical intervention.
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Affiliation(s)
- Sahyun Sung
- Department of Orthopedic Surgery, Yonsei University College of Medicine
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Jung-Hwan Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Yung Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joong Won Ha
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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23
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24
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Doctor PN, Verma M, Varaiya A, Merchant RH. Emphysematous osteomyelitis caused by Salmonella typhi in beta thalassemia major. J Postgrad Med 2020; 65:41-43. [PMID: 29882519 PMCID: PMC6380132 DOI: 10.4103/jpgm.jpgm_689_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There have been various cases of salmonella osteomyelitis reported in sickle cell anemia. We present a case of emphysematous osteomyelitis caused by Salmonella typhi in a 29-year-old beta thalassemia major patient. Diagnosis of emphysematous osteomyelitis was confirmed by computed tomography and magnetic resonance imaging, and culture of pus drained during surgical debridement confirmed the causative microorganism, Salmonella typhi. Antimicrobials were given according to microbiological sensitivity for a period of 8 weeks. Our patient also received hyperbaric oxygen therapy. At the end of therapy, he was afebrile and laboratory parameters normalized with a residual joint deformity which developed within 3 months.
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Affiliation(s)
- P N Doctor
- Department of Paediatrics, Nanavati Super Speciality Hospital, Vile Parle West, Mumbai, Maharashtra, India
| | - M Verma
- Department of Radiology, Nanavati Super Speciality Hospital, Vile Parle West, Mumbai, Maharashtra, India
| | - A Varaiya
- Department of Microbiology, Nanavati Super Speciality Hospital, Vile Parle West, Mumbai, Maharashtra, India
| | - R H Merchant
- Department of Paediatrics, Nanavati Super Speciality Hospital, Vile Parle West, Mumbai, Maharashtra, India
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25
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Tatakis FP, Kyriazis I, Panagiotopoulou IE, Kalafatis E, Mantzikopoulos G, Polyzos K, Kachrimanidis I, Vogiatzakis AM, Rellou S, Manta E, Tzaki M, Papaioannou V, Lelekis M. Simultaneous Diagnosis of Emphysematous Osteomyelitis and Emphysematous Pyelonephritis in a Diabetic Patient. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1793-1796. [PMID: 31787744 PMCID: PMC6913288 DOI: 10.12659/ajcr.920006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates. CASE REPORT A 57-year-old female with uncontrolled hyperglycemia presented to the emergency department with history of sudden onset of weakness, nausea, vomiting and diarrhea for 3 days and with a fall on the same level the previous day. Laboratory examinations revealed leukocytosis, lymphopenia, thrombocytopenia, deteriorated renal function, and hyperglycemic hyperosmolar non-ketotic state. She was placed on aggressive intravenous hydration and insulin infusion pump. Due to the deterioration of her medical condition, she underwent abdominal and pelvic CT scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis. Despite vigorous fluid resuscitation and systemic broad-spectrum antibiotic therapy, the patient's condition deteriorated further and eventually led to death within 48 h. CONCLUSIONS This case of fatal emphysematous osteomyelitis of the spine and EP serves as a significant reminder of those rare life-threatening entities, which affect patients with comorbidities, such as diabetes mellitus and other etiologies causing immunosuppression. The aim of the present case report is to highlight the importance and contribution of computed tomography in diagnosing these conditions and to emphasize the rare coexistence of these 2 emphysematous entities.
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Affiliation(s)
| | - Ioannis Kyriazis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece.,Diabetes and Obesity Outpatient Clinic, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Emmanuel Kalafatis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Konstantinos Polyzos
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | | | | | - Sofia Rellou
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | - Eleni Manta
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | - Maria Tzaki
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Moyssis Lelekis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece
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26
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Raju R, Kani K, Lischuk A, Wang A, Porrino J. Imaging of Emphysematous Osteomyelitis. PM R 2019; 11:322-324. [DOI: 10.1002/pmrj.12074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Rajiv Raju
- Yale Radiology and Biomedical Imaging330 Cedar Street New Haven Connecticut 06520
| | - Kimia Kani
- Department of RadiologyUniversity of Maryland School of Medicine, 22 S Greene Street Baltimore Maryland 21201
| | - Andrew Lischuk
- Yale Radiology and Biomedical Imaging330 Cedar Street New Haven Connecticut 06520
| | - Annie Wang
- Yale Radiology and Biomedical Imaging330 Cedar Street New Haven Connecticut 06520
| | - Jack Porrino
- Yale Radiology and Biomedical Imaging330 Cedar Street New Haven Connecticut 06520
- Diagnostic Radiology, University of Washington
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27
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Jolobe OMP. Optimising diagnostic strategies in emphysematous osteomyelitis. QJM 2019; 112:149. [PMID: 29939336 DOI: 10.1093/qjmed/hcy139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- O M P Jolobe
- From the Manchester Medical Society, Simon Building, Brunswick Street, Manchester, UK
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28
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Wong D, Holtom P, Spellberg B. Osteomyelitis Complicating Sacral Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy. Clin Infect Dis 2019; 68:338-342. [PMID: 29986022 PMCID: PMC6594415 DOI: 10.1093/cid/ciy559] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/06/2018] [Indexed: 12/19/2022] Open
Abstract
The treatment of osteomyelitis in patients with stage IV sacral pressure ulcers is controversial. We conducted a systematic literature review and did not find evidence of benefit of antibacterial therapy in this setting without concomitant surgical debridement and wound coverage. Furthermore, many patients with chronically exposed bone do not have evidence of osteomyelitis when biopsied, and magnetic resonance imaging may not accurately distinguish osteomyelitis from bone remodeling. The goal of therapy should be local wound care and assessment for the potential of wound closure. If the wound can be closed and osteomyelitis is present on bone biopsy, appropriate antibiotic therapy is reasonable. We find no data to support antibiotic durations of >6 weeks in this setting, and some authors recommend 2 weeks of therapy if the osteomyelitis is limited to cortical bone. If the wound will not be closed, we find no clear evidence supporting a role for antibiotic therapy.
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Affiliation(s)
- Darren Wong
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California (USC)
| | - Paul Holtom
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California (USC)
- Los Angeles County + USC Medical Center, California
| | - Brad Spellberg
- Division of Infectious Diseases, Keck School of Medicine, University of Southern California (USC)
- Los Angeles County + USC Medical Center, California
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29
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Lauer MF, Boschert EN, Dubin JR, Bernhardt M. Intramedullary Antibiotic Delivery for Emphysematous Osteomyelitis of the Femur. Orthopedics 2019; 42:e128-e130. [PMID: 30371923 DOI: 10.3928/01477447-20181023-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
The authors present a case of bilateral femoral emphysematous osteomyelitis caused by Escherichia coli in a 60-year-old woman with rheumatoid arthritis who was receiving long-term prednisone therapy. The infection in both femoral shafts was eradicated with surgical debridement, followed by insertion of intramedullary rods composed of culture-specific antibiotic cement into the femoral canals in conjunction with 6 weeks of intravenous antibiotics. The rods were subsequently removed, and no signs of further osteomyelitis were recognized at follow-up. To the authors' knowledge, this is the first case of its kind reported in the orthopedic literature. Emphysematous osteomyelitis, a rare and dangerous entity, can be successfully managed by intramedullary antibiotic delivery in the subacute setting. [Orthopedics. 2019; 42(1):e128-e130.].
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30
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Kim YK, Jo KM, Jang JH, Heo CM, Lee JH, Park JH, Kim S, Jang HJ, Kim HK, Kiem S. Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae. Infect Chemother 2018; 50:268-273. [PMID: 30270587 PMCID: PMC6167512 DOI: 10.3947/ic.2018.50.3.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.
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Affiliation(s)
- Yong Kyun Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyeong Min Jo
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Hoon Jang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Min Heo
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Ha Lee
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Han Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sunyoung Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hang Jae Jang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyeon Kuk Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sungmin Kiem
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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Affiliation(s)
- Mark Tp Mujer
- Internal medicine, Michigan State University, Sparrow hospital, Lansing, Michigan, USA.,Michigan State University, Internal Medicine, Lansing, Michigan, USA
| | - Manoj P Rai
- Michigan State University, Internal Medicine, Lansing, Michigan, USA
| | - Mohamed Hassanein
- Internal Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Subhashis Mitra
- Infectious disease, Michigan State University, Sparrow Hospital, Lansing, Michigan, USA
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32
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Abstract
Emphysematous osteomyelitis is a rare but potentially fatal infection. It is caused by gas-forming organisms and is characterized by the presence of intraosseous gas. A 75-year-old woman with untreated diabetes mellitus presented with difficulty in moving and anorexia. Laboratory studies revealed inflammation, a urinary infection, and diabetic ketoacidosis. Klebsiella pneumoniae was detected in both urine and blood cultures. Computed tomography and magnetic resonance imaging revealed emphysematous lesions in the paravertebral soft tissue, spinal canal, and iliopsoas muscle, with intraosseous gas at L1 and L2. These findings led to a diagnosis of emphysematous osteomyelitis. We herein review 35 reported cases of emphysematous osteomyelitis including our case.
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Affiliation(s)
- Ryohei Ono
- General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Koji Uehara
- General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Izumi Kitagawa
- General Internal Medicine, Shonan Kamakura General Hospital, Japan
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33
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Small JE, Chea P, Shah N, Small KM. Diagnostic Features of Emphysematous Osteomyelitis. Curr Probl Diagn Radiol 2018; 51:666-672. [DOI: 10.1067/j.cpradiol.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/19/2018] [Indexed: 11/22/2022]
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Abdelbaki A, Bhatt N, Gupta N, Li S, Abdelbaki S, Kumar Y. Emphysematous osteomyelitis of the forefoot. Proc (Bayl Univ Med Cent) 2018; 31:100-101. [PMID: 29686570 DOI: 10.1080/08998280.2017.1390338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Emphysematous osteomyelitis is a very rare, potentially fatal infection that requires immediate diagnosis and prompt treatment. Emphysematous osteomyelitis is usually considered whenever intraosseous gas is detected on imaging. Most organisms implicated in emphysematous osteomyelitis are members of the Enterobacteriaceae family or anaerobes; sometimes the infection is polymicrobial. We report a case of emphysematous osteomyelitis of the forefoot in a 33-year-old man with type 1 diabetes mellitus.
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Affiliation(s)
- Ahmed Abdelbaki
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Neeraj Bhatt
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Nishant Gupta
- Department of Radiology, Saint Vincent's Medical Center, Bridgeport, Connecticut
| | - Shuo Li
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Shady Abdelbaki
- Department of Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
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Tzeng BW, Liu PY, Hu SY. Acute respiratory distress syndrome associated with femoral osteomyelitis. Br J Hosp Med (Lond) 2018. [DOI: 10.12968/hmed.2018.79.3.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bo-Wei Tzeng
- Consultant, Department of Emergency Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou County, Taiwan
| | - Po-Yu Liu
- Consultant, Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Sung-Yuan Hu
- Consultant, Department of Emergency Medicine, Taichung Veterans General Hospital; School of Medicine, Institute of Medicine, Chung Shan Medical University; Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung 40705, Taiwan
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Lee J, Jeong CH, Lee MH, Jeong EG, Kim YJ, Kim SI, Kim YR. Emphysematous Osteomyelitis due to Escherichia coli. Infect Chemother 2017; 49:151-154. [PMID: 28271649 PMCID: PMC5500273 DOI: 10.3947/ic.2017.49.2.151] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022] Open
Abstract
Emphysematous osteomyelitis, especially that involving the extra-axial skeleton, is an extremely rare presentation but associated with significant morbidity and mortality. Here, we report a case in which a 58-year-old female patient with diabetes mellitus presented with emphysematous osteomyelitis that involved the sternum, clavicle, and pelvic bone and was caused by Escherichia coli via hematogenous spread of urinary tract infection. We successfully treated her with urgent and aggressive surgical drainage with prolonged antibiotics therapy. Early diagnosis and immediate surgical intervention are required for better outcomes in cases of emphysematous osteomyelitis.
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Affiliation(s)
- Jinhee Lee
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Chai Ho Jeong
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Myun Hee Lee
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Eun Gyo Jeong
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.
| | - Sang Il Kim
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Yang Ree Kim
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Chou DW, Yu CC. Nontyphoidal Salmonella Emphysematous Osteomyelitis. Am J Med Sci 2016; 354:635-636. [PMID: 29208263 DOI: 10.1016/j.amjms.2016.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/10/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Deng-Wei Chou
- Department of Critical Care Medicine, Tainan Municipal Hospital, Tainan, Taiwan.
| | - Chao-Chin Yu
- Department of Critical Care Medicine, Tainan Municipal Hospital, Tainan, Taiwan
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Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of the Knee. Case Rep Orthop 2016; 2016:1961287. [PMID: 27651965 PMCID: PMC5019922 DOI: 10.1155/2016/1961287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022] Open
Abstract
Emphysematous osteomyelitis is a rare but serious condition which is often associated with a fatal outcome. The typical appearances of emphysematous osteomyelitis are clusters of small gas bubbles within the medullary cavity. We report a case of a 62-year-old male who presented with emphysematous osteomyelitis due to hematogenous spread of Escherichia coli from the knee after arthroscopy.
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Affiliation(s)
- J L-Y Chen
- Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Y-S Huang
- Department of Medical Imaging, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Subacute hematogenous osteomyelitis is an insidious infection, which commonly has a delayed diagnosis. We describe the case of a 7-year-old boy with subacute osteomyelitis, which was initially considered to be a bone tumor. Infection should be considered in all cases of bone pain, especially in children, even in the absence of typical systemic features of inflammation.
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Kempen DHR, van Dijk M, Hoepelman AIM, Oner FC, Verlaan JJ. Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S502-7. [PMID: 25245891 DOI: 10.1007/s00586-014-3576-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome. METHODS A previously healthy 27-year-old man presented in the Emergency Department in septic shock because of Lemierre syndrome for which he was subsequently treated with intravenous benzylpenicillin for 2 months. Two and a half months later, the patient was readmitted with severe back pain without neurological deficits or fever. Imaging revealed an extensive vertebral osteomyelitis of the complete thoracic, lumbar and sacral spine. RESULTS Although the blood cultures obtained at the initial admission for Lemierre syndrome revealed Fusobacterium species and Streptococcus milleri, the cultures from the spinal biopsies remained negative. Histology of the spinal biopsies showed a purulent sclerosing osteomyelitis. The patient was successfully treated with intravenous piperacillin and tazobactam. Despite persisting back pain, no recurrence of infection was seen at 3 years of follow-up. CONCLUSION Lemierre syndrome and an extensive thoracolumbosacral vertebral osteomyelitis are rare but serious infections. Clinicians must maintain a high index of suspicion for infectious metastases leading to vertebral osteomyelitis when a patient presents with back pain after an episode of life-threatening septicaemia caused by Lemierre syndrome.
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Affiliation(s)
- D H R Kempen
- Department of Orthopaedics, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands,
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Aiyappan SK, Ranga U, Veeraiyan S. Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2014; 5:90-2. [PMID: 25210340 PMCID: PMC4158638 DOI: 10.4103/0974-8237.139207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We hereby report two cases of spontaneous emphysematous osteomyelitis of spine caused by gas forming organisms in diabetic patients, which were diagnosed using computed tomography (CT) and magnetic resonance imaging with one case managed successfully. These cases highlight the role of CT in diagnosis of gas forming spinal infections, especially in diabetic patients. Early and aggressive management is required in those cases to avoid mortality.
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Affiliation(s)
- Senthil Kumar Aiyappan
- Department of Radiodiagnosis and Imaging, Saveetha Medical College and Hospital, Thandalam, Kancheepuram, Tamil Nadu, India
| | - Upasana Ranga
- Department of Radiodiagnosis and Imaging, Saveetha Medical College and Hospital, Thandalam, Kancheepuram, Tamil Nadu, India
| | - Saveetha Veeraiyan
- Department of Radiodiagnosis and Imaging, Saveetha Medical College and Hospital, Thandalam, Kancheepuram, Tamil Nadu, India
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A case of emphysematous osteomyelitis of the midfoot: imaging findings and review of the literature. Case Rep Radiol 2014; 2014:616184. [PMID: 25013735 PMCID: PMC4070323 DOI: 10.1155/2014/616184] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/29/2014] [Indexed: 11/19/2022] Open
Abstract
Emphysematous osteomyelitis is a rare but potentially fatal condition that must be considered whenever intraosseous gas is identified on imaging. The organisms implicated in most cases of emphysematous osteomyelitis are anaerobes or members of the Enterobacteriaceae family. Significant comorbidities, such as malignancy and diabetes mellitus, frequently predispose to this condition, and high mortality rates have been reported. The radiologist must be aware of the implications of identifying intraosseous gas in order to facilitate early diagnosis and expedite management. We report a unique case of a 58-year-old male with diabetes mellitus who presented with emphysematous osteomyelitis of the midfoot and necrotising fasciitis of the ipsilateral distal lower limb. Specimen cultures in this case revealed a pure growth of Group G Streptococcus.
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Kivrak AS, Sumer S, Demir NA, Aydin BK. The life-saving little tip: intraosseous gas. BMJ Case Rep 2013; 2013:bcr-2013-201648. [PMID: 24311426 DOI: 10.1136/bcr-2013-201648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A case is presented of an-aerobic osteomyelitis with intraosseous gas resulting in the extension of gas in soft tissue structures in a patient with diabetes mellitus. The finding of intraosseous gas and its extension into the pubic joint and the left anterior abdominal wall is depicted. Intraosseous gas is a rare but worrying finding for osteomyelitis in the absence of a penetrative wound, recent surgery, biopsy or fracture.
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Affiliation(s)
- Ali Sami Kivrak
- Department of Radiology, Selcuk University Medical Faculty, Konya, Turkey
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