Emphysematous osteomyelitis of the forefoot

Abstract

Emphysematous osteomyelitis is a very rare, potentially fatal infection that requires immediate diagnosis and prompt treatment. Emphysematous osteomyelitis is usually considered whenever intraosseous gas is detected on imaging. Most organisms implicated in emphysematous osteomyelitis are members of the Enterobacteriaceae family or anaerobes; sometimes the infection is polymicrobial. We report a case of emphysematous osteomyelitis of the forefoot in a 33-year-old man with type 1 diabetes mellitus.

Keywords: Diabetes; emphysematous osteomyelitis; midfoot; necrotizing fasciitis.

Figure 1.

(a) Frontal, (b) oblique, and (c) lateral views of the left leg demonstrating evidence of prior transmetatarsal amputation. Marked soft tissue swelling is evident on the lateral film, and foci of air are evident in the subcutaneous and deep soft tissues (white arrow), with a large pocket of air along the lateral aspect of the foot (curved white arrow). A chronic fracture deformity of the left fifth metatarsal is also shown (black arrow).

Figure 2.

(a) Axial and (b) coronal noncontrast CT scan of the leg demonstrating a moderate amount of deep air (curved black arrow) and evidence of bone destruction (curved white arrow) with air in the cancellous portion of the second metatarsal (black arrow). There is 2.0 × 1.6 cm fluid collection with air fluid level along the lateral aspect of the foot (white arrow).