Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae

Abstract

Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.

Strongyloides Hyperinfection Associated with Enterococcus faecalis Bacteremia, Meningitis, Ventriculitis and Gas-Forming Spondylodiscitis: A Case Report

“…Gas-forming spondylodiscitis is an uncommon radiological finding [11][12][13][14][15]. Common causes of emphysematous osteomyelitis include anaerobes, Gram-negative organisms (e.g., K. pneumoniae, E. coli) and Staphylococcus aureus [12][13][14][15]; though, E. faecalis has previously been reported as a cause of gas-forming spinal epidural abscess [11]. In our patient, the only positive microbiology was E. faecalis isolated from the bloodstream.…”

“…However, while larva currens and cutaneous manifestations of Strongyloides hyperinfection are well-documented [5], dissemination to deep soft tissue and spinal involvement is less commonly reported [1][2][3]. Gas-forming spondylodiscitis is an uncommon radiological finding [11][12][13][14][15]. Common causes of emphysematous osteomyelitis include anaerobes, Gram-negative organisms (e.g., K. pneumoniae, E. coli) and Staphylococcus aureus [12][13][14][15]; though, E. faecalis has previously been reported as a cause of gas-forming spinal epidural abscess [11].…”

Characteristics of gas-forming pyogenic liver abscess caused by Klebsiella pneumoniae and Clostridi perfringens

“…With regard to laboratory investigations (Table 3 [11][12] and Table 4 [8,[38][39][40][41][42][43][44][45][46][47]), patients with GFPLA-Cp had higher levels of aspartate aminotransferase (AST) (869.20 ± 583.02 IU/L versus 233.12 ± 98.19 IU/L, P=0.007) and alanine aminotransferase (ALT) (609.00 ± 516.26 IU/L versus 199.85 ± 74.93 IU/L, P=0.034) than patients with GFPLA-Kp at hospital admission. However, no statistically significant differences were found in alkaline phosphatase levels between the 2 patient groups.…”

“…Statistical differences were considered significant at a P value ˂0.05. Table 1 [11][12] and Table 2 [8,[38][39][40][41][42][43][44][45][46][47] show the clinical characteristics and laboratory test results of patients with GFPLA-Kp (12 cases) and patients with GFPLA-Cp (24 cases). The mean ages of patients with GFPLA-Kp and patients with GFPLA-Cp were 67.08 ± 10.22 years and 66.70 ± 8.78 years, respectively.…”

Emphysematous osteomyelitis of the spine: a case report and case based review of the literature

“…Compared to the patient’s age, the particular comorbidities a patient may have likely contributes to the development of EO of the spine. While only four of the reported cases had no comorbidities (or no mention was made), the remaining 25 cases had significant ones including diabetes mellitus (44.8%) ( 2 , 4 , 9 , 11 , 14 , 15 , 19 , 20 , 22 - 24 , 26 ), malignancy (10.3%) ( 10 , 12 , 18 , 25 ) alcoholism (10.3%) ( 5 , 16 ) or steroid therapy (6.9%) ( 5 , 21 ). These findings are unsurprising as diabetes mellitus has a multifactorial role in increasing susceptibility to infection through various means such as cytokine production impairment and dysfunction of macrophages/neutrophils ( 27 ).…”