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Surgical treatment of Emphysematous Osteomyelitis of the spine in malnutrition and anemia patient: a rare case report

Year: 2026

Type: article

Abstract: Emphysematous Osteomyelitis is a rare and potentially fatal form of severe osteomyelitis. It is characterized by gas produced by pathogenic bacteria accumulating in bone structures and surrounding soft tissues. Its rarity and severe nature pose significant challenges for diagnosis and treatment. This case report describes the diagnosis and treatment of Emphysematous Osteomyelitis of the spine in a patient with long-term malnutrition and anemia. A 72-year-old agricultural worker presented with persistent low back pain accompanied by radiating pain in both lower limbs for one month. The patient reported continuous dull pain that worsened with postural changes and improved when lying flat. Based on clinical presentation, biochemical indicators, and imaging studies, spinal infection was initially suspected. Empirical antimicrobial therapy administered for two weeks after admission proved ineffective and was complicated by an epidural abscess, leading to the decision for surgical intervention in the third week. Intraoperative tissue samples were identified through culture identification and high-throughput culture and metagenomic pathogen detection, identifying Citrobacter koseri and Staphylococcus aureus as causative pathogens. Postoperatively, based on antimicrobial susceptibility testing results, treatment was switched to intravenous meropenem and levofloxacin. One month postoperatively, the patient showed good recovery with normalized infection markers, no fever, and significant pain relief. In summary, this rare and severe form of Emphysematous Osteomyelitis requires prompt diagnosis and treatment in clinical practice. The diagnosis of Emphysematous Osteomyelitis of the spine relies on imaging studies. Failure to achieve accurate and timely diagnosis may lead to misdiagnosis or delayed treatment, which not only compromises therapeutic efficacy but may also result in catastrophic consequences. Timely antibiotic therapy, early detection, and aggressive surgical intervention when necessary are key to the successful management of Emphysematous Osteomyelitis of the spine. Diagnosing and treating spinal infections poses significant challenges. When rare spinal infections occur, prompt diagnosis and treatment are essential for achieving a favorable prognosis. Emphysematous Osteomyelitis of the spine often requires surgical intervention to achieve optimal therapeutic outcomes. Following intraoperative sampling and testing, treatment should be immediately switched to appropriately sensitive antibiotics. This case underscores that prompt diagnosis and treatment are essential for favorable outcomes when rare cases of Emphysematous Osteomyelitis of the spine occur.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-025-12217-2