Infect Chemother.  2018 Sep;50(3):268-273. 10.3947/ic.2018.50.3.268.

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

• Kim YK
• Jo KM
• Jang JH
• Heo CM
• Lee JH
• Park JH
• Kim S
• Jang HJ
• Kim HK
• Kiem S

• KMID: 2420912
• DOI: http://doi.org/10.3947/ic.2018.50.3.268

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.

Keyword

Emphysematous osteomyelitis; Klebsiella pneumoniae; Liver abscess; Diabetes mellitus

MeSH Terms

Abscess
Comorbidity
Diabetes Mellitus
Diagnosis
Enterobacteriaceae
Epidural Space
Humans
Klebsiella pneumoniae*
Klebsiella*
Liver Abscess*
Liver*
Osteomyelitis*

Figure

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  Figure 1 Non-enhanced abdominopelvic computed tomography demonstrates emphysematous osteomyelitis of L5 and the sacrum (A, B).

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  Figure 2 Axial (A) and sagittal (B) abdominopelvic computed tomography images show multiple air bubbles within the epidural space (L3-S5), retroperitoneum, paravertebral muscles, and right psoas muscle.

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  Figure 3 Contrast-enhanced abdominopelvic computed tomography shows Klebsiella pneumoniae abscesses (arrows) in the right hepatic dome.

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  Figure 4 Chest computed tomography shows multiple peripheral patchy consolidations and ground-glass opacities in both the lungs, suggesting septic pneumonia.

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  Figure 5 Brain diffusion weighted magnetic resonance imaging shows multifocal cortical infarctions bilaterally involving the frontoparietal, and temporal lobes and cerebellum (A, B).

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