Challenging case of an intramedullary tibial abscess in the setting of chronic osteomyelitis

Description 

This is the case of a 43-year-old wheelchair-user man with a history of hepatitis C, cirrhosis, intravenous drug abuse and a 2-year history of chronic right lower extremity ulcers who presented to the emergency department with 4 days of worsening right leg pain. On physical exam, there was a new area of fluctuance on the anterior tibial surface. Labs included a white cell count of 9.3 K/µL, C reactive protein of 129 mg/L and erythrocyte sedimentation rate of 90 mm/hour. A CT scan demonstrated proximal tibia osteomyelitis with an intramedullary abscess, surrounding soft tissue abscesses and septic arthritis of the knee joint (figure 1).

Figure 1

(A) Permeative appearance of the proximal tibial metaphysis and diaphysis with areas of cortical lucency and endosteal scalloping, suspicious for osteomyelitis. (B) Intramedullary fluid collection within the proximal tibial metaphysis/epiphysis, containing hyperattenuating contents with two punctate foci of air measuring approximately 6.7x4.7x16.6 cm,...

https://ift.tt/2Nolq7u