Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jul 3;16(7):e63748.
doi: 10.7759/cureus.63748. eCollection 2024 Jul.

Emphysematous Osteomyelitis of the Lumbar Spine and Sacrum After Liver Transplantation: A Case Report

Rio Kou  1 , Yasuyuki Onishi  1 , Satoshi Ogiso  2 , Shinichi Kai  3 , Yuji Nakamoto  1
Affiliations
Case Reports

Emphysematous Osteomyelitis of the Lumbar Spine and Sacrum After Liver Transplantation: A Case Report

Rio Kou et al. Cureus. .

Abstract

Emphysematous osteomyelitis (EO) is a rare and potentially fatal disease that often occurs in patients with underlying conditions, most commonly diabetes mellitus. Herein, we report a case of a 62-year-old man who presented with fever, tachycardia, and hypotension 112 days after liver transplantation. Blood tests revealed an increased inflammatory response. Computed tomography demonstrated clusters of small gas collections in the first and second lumbar vertebral bodies and the right sacral ala, a finding characteristic of the pumice stone sign of EO. Septic shock due to EO was diagnosed. The patient responded well to treatment and recovered from the infection. This case suggests that the immunosuppressive state after liver transplantation is a risk factor for EO.

Keywords: emphysematous osteomyelitis; immunosuppression; liver transplantation; pumice stone sign; septic shock.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography (CT) images of the lumbosacral spine obtained 112 days after liver transplantation.
(A) Coronal CT image of the lumbar spine shows clusters of small intraosseous gas (arrows) in the first and second lumbar vertebral bodies, extraosseous gas (arrowheads) around the vertebral bodies, and compression fractures of the first and second lumbar vertebral bodies. (B) Coronal CT image of the sacrum shows clusters of small intraosseous gas (arrow) in the right sacral ala.
Figure 2
Figure 2. Computed tomography (CT) images of the lumbosacral spine obtained 118 days after liver transplantation.
(A) Coronal CT image of the lumbar spine shows a decrease in intraosseous gas (arrows) in the first and second lumbar vertebral bodies. No extraosseous gas is observed. (B) Coronal CT image of the sacrum shows no intraosseous gas in the right sacral ala (arrow).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. CT detection of intraosseous gas: a new sign of osteomyelitis. Ram PC, Martinez S, Korobkin M, Breiman RS, Gallis HR, Harrelson JM. AJR Am J Roentgenol. 1981;137:721–723. - PubMed
    1. Emphysematous osteomyelitis: a case report and review of the literature. Luey C, Tooley D, Briggs S. Int J Infect Dis. 2012;16:0–20. - PubMed
    1. Anaerobic osteomyelitis associated with intraosseous and soft-tissue pneumatosis. Son JS, Seo JB. Pediatr Radiol. 2009;39:1253. - PubMed
    1. Gas in vertebrae. Osawa H, Komagamine J, Sato Y. Am J Med. 2021;134:0–1. - PubMed
    1. Diagnostic features of emphysematous osteomyelitis. Small JE, Chea P, Shah N, Small KM. Curr Probl Diagn Radiol. 2022;51:666–672. - PubMed

Publication types

LinkOut - more resources