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

Resources:

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