A case of emphysematous osteomyelitis of the midfoot: imaging findings and review of the literature.

Marcela Mautone,Parm Naidoo,Jessica Gray

doi:10.1155/2014/616184

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.

Highlights

The presence of intraosseous gas in the absence of direct communication between bone and air, such as a compound fracture or recent surgery, is highly suggestive of emphysematous osteomyelitis [1, 2]
We report a 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 and a pure growth of Group G Streptococcus from specimen cultures
Since Ram and colleagues’ first description of emphysematous osteomyelitis in 1981 [3], the prevalence has been very low, and only 25 cases had been reported in English literature to 2011 [5]

Summary

Imaging Findings and Review of the Literature

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. 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

Introduction

Case Presentation

Discussion