Emphysematous Osteomyelitis

• Published in: Applied radiology (1976) Vol. 50; no. 3; pp. 56 - 56B
• Main Authors: Christiansen, Eric M, Cox, Chad, Matthess, Nicholas, Hughes, Jeremy
• Format: Journal Article
• Language: English
• Published: Scotch Plains Anderson Publishing Ltd 01.05.2021
• Subjects: Biomedical materials; Blood cell count; Diabetes; Edema; Emergency medical services; Epidural; Leukocytes; Osteonecrosis
• ISSN: 1879-2898; 0160-9963; 1879-2898
• DOI: 10.37549/AR2730

CASE SUMMARY_ A 77-year-old with a history of diabetes presented to the emergency department with a chief complaint of low back pain after a ground-level fall. Pertinent laboratory values included markedly elevated glucose of 967, low sodium of 121, and elevated white blood cell count of 12.6. The condition is most commonly seen in diabetic patients without gender or age predilection and its mortality is reported to be as high as 35%.2 Most cases are monomicrobial, related to bacteremia with gas-forming organisms, with fusibacterium being most common.3 Hematogeneous dissemination is the most common route of spread; however, it has also been noted to develop from spinal surgery, an intra-abdominal source, or from skin or soft-tissue infections.4 Intraosseous gas within the appendicular skeleton is pathognomonic for EO in the absence of recent procedure/ intervention.5 However, intraosseous gas seen within a vertebral body is more commonly related to non-infectious causes, such as degenerative or post-procedural changes, neoplasia, or osteonecrosis.2-4 Clinical history and imaging findings elsewhere (ie, septic emboli, as in our case) suggest EO as the underlying diagnosis.