What's the diagnosis? By Dr. Sydney Tabaac

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



Answer: Osteomyelitis 




  • Etiology 
    • Hematogenous: more common; seeding in setting of bacteremia
      • usually monomicrobial - S. aureus (most common), aerobic gram negative rods
    • Non-hematogenous: spread from adjacent soft tissue and joints or direct inoculation (i.e., trauma, surgery)
      • polymicrobial or monomicrobial - S. aureus, coag-negative staph, aerobic gram negative bacilli
  • Risk factors: DM, IVDU, vasculopathy, recent invasive procedures
  • Differential: soft tissue infection, charcot arthropathy, osteonecrosis, gout, fracture, bursitis, bone tumor
  • Labs: CBC, ESR, CRP, blood cultures
  • Imaging: test of choice is MRI
  • Confirmation: bone biopsy for culture
  • Treatment: 4-6 weeks of antibiotics (+/- surgery)




  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