Emphysematous osteomyelitis: a case report and review of the literature

Abstract

We report the case of a 15-year-old girl with pelvic and sacral emphysematous osteomyelitis caused by Fusobacterium necrophorum. This infection was cured following four surgical procedures and 4 weeks of intravenous then 4 weeks of oral antibiotics. We review our case alongside the 24 previously reported cases of emphysematous osteomyelitis in the literature. The 25 cases include 15 monomicrobial and 10 polymicrobial infections. The causative organism(s) in all but three cases included an anaerobe or a member of the Enterobacteriaceae family. A significant underlying comorbidity was reported in 18 cases. At least 15 cases required one or more surgical procedures. There was a significant associated mortality with eight (32%) patients dying in hospital at 7 to 56 days after the diagnosis of emphysematous osteomyelitis.

Emphysematous osteomyelitis of the forefoot

“…6 Most cases are associated with immunosuppression as a result of diabetes or malignancies. 5 Our patient suffered from poorly controlled type 1 diabetes with a blood sugar of 387 mg/dL upon presentation. According to Luey et al, the mean age at presentation is 51 years with no sex predilection.…”

“…According to Luey et al, the mean age at presentation is 51 years with no sex predilection. 5 The infection can be monomicrobial or polymicrobial, with the most commonly isolated organism being either a member of the Enterobacteriaceae family or anaerobes. 5 In our case, tissue and blood cultures indicated growth of S. aureus and P. penneri.…”

“…3,4 Conditions resulting in immunodeficiency such as diabetes predispose patients to emphysematous osteomyelitis. 5 We report a young man with type 1 diabetes who presented with emphysematous osteomyelitis of the midfoot and necrotizing fasciitis of the distal lower limb.…”

Emphysematous Osteomyelitis due to Escherichia coli

“…Until now, only 29 cases have been reported in the English literature globally [1678]. The involving sites of osteomyelitis of reported cases were vertebrae, pelvis, sacrum, femur, tibia, fibula, and midfoot [1678].…”

Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome

“…Fusobacterium infections of the spine are very rare with only 15 previously reported cases in the literature [20][21][22][23][24][25][26][27][28][29][30][31][32]. So far, these infections were limited to two-, three-or fourlevel spondylodiscitis located mainly in the lumbar area.…”