Infect Chemother.  2017 Jun;49(2):151-154. 10.3947/ic.2017.49.2.151.

Emphysematous Osteomyelitis due to Escherichia coli

• Lee J
• Jeong CH
• Lee MH
• Jeong EG
• Kim YJ
• Kim SI
• Kim YR

• KMID: 2383939
• DOI: http://doi.org/10.3947/ic.2017.49.2.151

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.

Keyword

Emphysematous osteomyelitis; Escherichia coli; Urinary tract infection

MeSH Terms

Anti-Bacterial Agents
Clavicle
Diabetes Mellitus
Drainage
Early Diagnosis
Escherichia coli*
Escherichia*
Female
Humans
Middle Aged
Mortality
Osteomyelitis*
Pelvic Bones
Skeleton
Sternum
Urinary Tract Infections
Anti-Bacterial Agents

Figure

• 

  Figure 1 The chest and abdominal computed tomography (CT) scan at admission showed intraosseous gases involving the sternum (arrow) (A), left clavicle with swelling and intra-muscular gases in the adjacent muscle and soft tissues (arrow) (B). Intraosseous gases are noted in the right iliac bone and sacroiliac joint (arrow) (C). The CT scan showed a hypodense wedge-shaped lesion in the right lower kidney,(arrow) which indicated acute pyelonephritis with abscesses (D).

• 

  Figure 2 Follow-up chest and abdominal computed tomography scans at 12 weeks after admission showed emphysematous osteomyelitis in sternum and left clavicle with adjacent cellulitis are almost improved (A,B). Also, emphysematous osteomyelitis in the right iliac bone and sacroiliac joint are almost resolved (C).

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