What's the diagnosis? By Dr. Sydney Tabaac


A 65 yo male PMH HTN, HLD presents with left foot pain and swelling.  An x-ray is is done.  What's the diagnosis?  Scroll down for answer.





Answer:  Osteomyelitis of the great toe with soft tissue swelling noted by the radiologist





Osteomyelitis: an infection involving bone

  • Mechanism:
      • Hematogenous: more common, seeding in the setting of bacteremia; usually monomicrobial S aureus (most common), aerobic gram negative rods
      • Non-hematogenous: from adjacent soft tissue or direct innoculation (trauma or surgery); polymicrobial or monomicrobial, S aureus, coag-negative staph, aerobic gram negative rods
  • Differential: soft tissue infection, charcot arthropathy, osteonecrosis, gout, fracture, bursitis, bone tumor
  • Risk factors: diabetes, IV drug use, vasculopathy, trauma or surgical procedure
  • Work up:
      • Labs including CBC, ESR, CRP, blood culutres
      • Imaging test of choice is MRI
  • Treatment - consult surgery for surgical debridement with bone biopsy and then 4-6 weeks of antibiotics




1. Grosheider, Thomas, and Suzanne M. Shepherd.. "Injection Drug Users." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016

2. Lalani, T, and Schmitt K (2019). Osteomyelitis in adults: Clinical Manifestations and Diagnosis. UpToDate. Retrieved November 19, 2019. From https://www.uptodate.com/contents/osteomyelitis-in-adults-clinical-manifestations-and-diagnosis?search=osteomyelitis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2