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Case Reports
. 2018 Jul 15;57(14):2081-2087.
doi: 10.2169/internalmedicine.0219-17. Epub 2018 Mar 9.

Emphysematous Osteomyelitis of the Spine: A Case Report and Literature Review

Ryohei Ono  1 , Koji Uehara  1 , Izumi Kitagawa  1
Affiliations
Case Reports

Emphysematous Osteomyelitis of the Spine: A Case Report and Literature Review

Ryohei Ono et al. Intern Med. .

Abstract

Emphysematous osteomyelitis is a rare but potentially fatal infection. It is caused by gas-forming organisms and is characterized by the presence of intraosseous gas. A 75-year-old woman with untreated diabetes mellitus presented with difficulty in moving and anorexia. Laboratory studies revealed inflammation, a urinary infection, and diabetic ketoacidosis. Klebsiella pneumoniae was detected in both urine and blood cultures. Computed tomography and magnetic resonance imaging revealed emphysematous lesions in the paravertebral soft tissue, spinal canal, and iliopsoas muscle, with intraosseous gas at L1 and L2. These findings led to a diagnosis of emphysematous osteomyelitis. We herein review 35 reported cases of emphysematous osteomyelitis including our case.

Keywords: Klebsiella pneumoniae; diabetes mellitus; emphysematous osteomyelitis; gas-forming organisms; intraosseous gas; review of the literature.

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Figures

Figure 1.
Figure 1.
Computed tomography image of the abdomen showing emphysematous lesions around the spine (red arrows) as well as the presence of intraosseous air (blue arrows).
Figure 2.
Figure 2.
Computed tomography image of the abdomen showing emphysematous lesions around the spine (red arrows) as well as the presence of intraosseous gas (blue arrows).
Figure 3.
Figure 3.
A STIR sequence in the MRI image showing a high signal at L1 and L2: (A) Sagittal view. (B) Coronal view. STIR: short TI inversion recovery
Figure 4.
Figure 4.
Characteristics of emphysematous osteomyelitis.
See this image and copyright information in PMC

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