Gas-forming vertebral osteomyelitis in diabetic patients

Chen, Chan-Wei; Yang, Chi-Jack; Huang, Jeng-Jong; Chuang, Yin-Ching; Young, Chenden

doi:10.3109/00365549109023410

Cited by 14 publications

(9 citation statements)

References 4 publications

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“…[13] Pyogenic osteomyelitis of spine should be considered in the differential diagnosis of patients, particularly with diabetes presenting with low back pain and if associated with intravertebral air, an aggressive approach of treatment is advised. [2567] Any delay in diagnosis and treatment can be associated with worsened outcome. [2] MRI is the ideal investigation of choice for evaluating vertebral infections and the reported sensitivity and specificity are 96% and 93%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases

Aiyappan

Ranga

Veeraiyan

2014

J Craniovert Jun Spine

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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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Section: Discussionmentioning

confidence: 99%

Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases

Aiyappan

Ranga

Veeraiyan

2014

J Craniovert Jun Spine

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“…Staphylococcus aureus has been found to be the most common cause of infection in athletes [1,15]; Pseudomonas aeruginosa and Serratia marcescens are found more frequently in intravenous drug abusers [10,16]; and osteomyelitis caused by Salmonella and Propionibacterium has been well described in patients with sickle cell disease [11,17,18]. Even though osteomyelitis caused by Klebsiella pneumoniae has previously been observed in diabetes mellitus patients [1,19-21], very few case series have reported such a high percentage of femur osteomyelitis in this setting. We found that Klebsiella pneumoniae was isolated in 60% of bone-tumor-mimicking femur osteomyelitis patients.…”

Section: Discussionmentioning

confidence: 99%

Osteomyelitis of the femur mimicking bone tumors: a review of 10 cases

Huang

Chen

et al. 2013

World J Surg Onc

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BackgroundThe clinical symptoms and radiographic appearance of osteomyelitis can mimic those of bone tumors.MethodsWe reviewed 10 patients with osteomyelitis of the femur who were initially diagnosed as having bone tumors and were subsequently transferred to our institution.ResultsNocturnal pain of moderate intensity occurred in seven patients, and all 10 patients had elevated C-reactive protein levels. The radiographic findings included the following: a permeative, moth-eaten osteolytic lesion in six patients, an osteolytic lesion with sclerotic borders in three patients, and cortical destruction with pathological fracture in one patient. Magnetic resonance imaging was performed for eight patients, and only one had a positive penumbra sign. All patients underwent a surgical biopsy to confirm the final diagnosis for histological analysis and cultures. Klebsiella pneumoniae was detected in six patients and Staphylococcus aureus, the most common organism in osteomyelitis, was detected in three. Recurrence of infection occurred in five patients following debridement surgery; of these three had a Klebsiella pneumoniae infection. All patients received antibiotic treatment for an average of 20.4 weeks (range, 4 to 44) and surgical treatment an average of 1.8 times (range, 1 to 4). At the final follow-up, all patients were fully recovered with no signs of infection.ConclusionsWhen used in combination, clinical examinations, laboratory data, and radiographic findings can reliably distinguishing osteomyelitis from bone tumors.

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“…This pattern is nonspecific and has been reported in osteomyelitis associated with Escherichia coli, Klebsiella pneumonia, Salmonella spp., Peptostreptococcus, Clostridia, brucellosis, and tuberculosis. [36][37][38] Gas formation indicates a severe necrotic process that cannot be adequately treated by intravenous antibiotics. Radical surgical debridement is recommended if the patient is fit for an surgery performed under general anesthesia.…”

Section: Diagnosismentioning

confidence: 99%

“…Radical surgical debridement is recommended if the patient is fit for an surgery performed under general anesthesia. 37,38 When the spine is involved, radiographs show destruction with varying degrees of collapse. Melioidosis can involve both vertebral bodies and posterior elements of the spine.…”

Section: Diagnosismentioning

confidence: 99%

Musculoskeletal Melioidosis

Pattamapaspong¹,

Muttarak²

2011

Semin Musculoskelet Radiol

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Melioidosis is an infectious disease caused by Burkholderia pseudomallei, mostly affecting patients in Southeast Asia and northern Australia. The disease has been increasingly recognized around the world due to the increased levels of travel and population movement. Clinical manifestations of melioidosis range from fulminant septicemic illness to an indolent local infection. The disease often involves multiple organs, including the lung, spleen, liver, and other visceral organs. Musculoskeletal infection is usually seen as a part of multiorgan involvement, but localized musculoskeletal involvement may occur. The most common manifestation of musculoskeletal melioidosis is septic arthritis, followed by osteomyelitis, pyomyositis, and soft tissue abscesses. The clinical and radiological manifestations of musculoskeletal melioidosis are nonspecific, and the diagnosis needs a high level of suspicion. Associated infection of lungs and visceral organs is suggestive of melioidosis. The disease requires special laboratory facilities and treatment. Inappropriate or inadequate treatment leads to high mortality rate or long-term relapse of the disease. The causative organism of melioidosis, clinical manifestations, and imaging features of musculoskeletal melioidosis are reviewed.

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Gas-forming vertebral osteomyelitis in diabetic patients

Cited by 14 publications

References 4 publications

Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases

Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases

Osteomyelitis of the femur mimicking bone tumors: a review of 10 cases

Musculoskeletal Melioidosis

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