Endocrine Abstracts

Introduction/Objectives: Emphysematous osteomyelitis is a rare disease, characterized by the presence of intraosseous gas associated with an infectious process. It occurs in patients with chronic pathologies such as diabetes mellitus, and has high mortality. The most common location is the vertebral, sacral, femur, pelvis, tibia and fibula, while it is extremely rare in the foot.

Material/Method: With the help of the Radiology service of our hospital, we collected cases of emphysematous osteomyelitis diagnosed by imaging (CT or MRI) in diabetic patients at the Regional Hospital of Malaga during the year 2023: one in the pubis and two in the foot. 2 men and 1 woman with an average age of 60-70 years and diabetes with poor metabolic control, case 1 died during admission. Case 1 70-year-old man, ex-smoker, type 2 diabetes and dyslipidemia. He was admitted for grade IV peripheral arterial disease with dry necrotic plaque on both forefeet of MMII and dry necrosis in the toes of the left foot, leukocytosis and elevated CRP. In Angio -CT of the Lower Limbs, he presented radiological signs of osteomyelitis in both feet, affecting the left calcaneus (emphysematous osteomyelitis) and phalanges bilaterally. Subcutaneous emphysema and collections adjacent to both calcaneus. EXITUS Case 2: A 62-year-old man, poorly controlled type 2 diabetes, poor adherence to treatment, diabetic polyneuropathy, previous amputations and peripheral arterial disease with ulcers in both lower limbs. He went to the emergency room due to metabolic decompensation and poor progress of a left plantar ulcer. Computed tomography and magnetic resonance imaging showed emphysematous osteomyelitis in the midfoot and forefoot, with extensive abscessed inflammatory involvement of adjacent soft tissues. Intravenous antibiotic treatment was initiated with subsequent infratuberosal amputation. HOSPITAL DISCHARGE Case 3. 63-year-old woman, DM on insulin. Cutaneous lupus. He was admitted for left pyelonephritis with areas of abscessation, with probable superinfection of the cortical cyst in the upper pole complicated with emphysematous osteomyelitis affecting the pubis. Complicated evolution with pelvic collections and emphysematous osteomyelitis of the pubis. Percutaneous drainage was performed, isolating E. coli, the same germ isolated in urine and blood cultures. HOSPITAL DISCHARGE

Conclusion: Imaging tests play an essential role in making early diagnosis and treatment, and reducing the mortality rate. CT can evaluate bone gas and MRI can evaluate soft tissues. Treatment is based on surgical debridement, amputation and intravenous antibiotic therapy.