Near-miss Osteomyelitis in an Immunosuppressed Crohn’s Disease Patient: Diagnostic Vigilance Sparked by a Medical Student
Year: 2025
Type: article
Study design: Case Report
Abstract: Crohn's disease (CD) patients on immunosuppressive therapy are at increased risk of infections, including osteomyelitis, which could be diagnostically challenging. This case highlights the importance of medical student vigilance in making a near-miss diagnosis of osteomyelitis in a CD patient. A 56-year-old CD patient developed left shoulder pain following localized muscle injection and was initially managed as a soft-tissue abscess. The condition worsened despite 21 days of antibiotics. Investigation: Cultures were positive for methicillin-sensitive Staphylococcus aureus (MSSA). Persistent pain and new neurologic complaints prompted an MRI (T1 hypointensity, T2-STIR hyperintensity, post-contrast enhancement) at 60 days, in support of osteomyelitis without bone biopsy. Management/Outcome: The patient received 6 weeks of intravenous vancomycin (1 g every 12 hours), followed by oral antibiotics, resulting in partial relief of pain (pain score: 8/10 to 4/10) and improvement in shoulder function (Constant-Murley score: 30 to 65 at 3 months). Immunotherapy (adalimumab) was restarted after infection control. This case highlights three practical lessons: maintaining a low threshold for advanced imaging in immunosuppressed patients with persistent pain; incorporating diagnostic time-outs to invite trainee perspectives; and seeking early infectious-disease consultation when osteomyelitis is suspected.
Source: ASIDE Health Sciences
Authors: Abbas Al Bazzal, Aya Kawssan, Atef Akoum, Dayana Majid Kamar, Mohammad Ali Mtairek, Hiba Hamdar
Institutions: Lebanese University, Damascus University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414514092