Emphysematous osteomyelitis complicated with liver abscess and pulmonary infection in a diabetic patient: a case report

• Emphysematous osteomyelitis (EO) tends to occur in immunocompromised populations. • The CT imaging feature of emphysematous osteomyelitis is the “pumice stone sign”. • EO should be considered if gas is observed in axial bones and adjacent tissues. • Klebsiella pneumoniae is a common pathogenic bacterium in emphysematous osteomyelitis. • Early and precise antibiotic treatment is crucial for emphysematous osteomyelitis. Emphysematous osteomyelitis (EO) is a life-threatening bone infection. In this case, we present a 67-year-old male patient with congenital deaf-mutism, hypertension, and diabetes mellitus. He was admitted to the emergency department due to “altered mental status for 2 h”, and blood tests revealed a significant elevation of infectious markers. Computed tomography (CT) scans showed multiple gas-density shadows in the L3 vertebral body, along with pneumocele in the spinal canal at the same level, the right psoas major muscle, and the diaphragm. Abdominal CT examination indicated a liver abscess in the right lobe of the patient’s liver. Pulmonary CT suggested multiple infectious lesions in the lungs. Subsequent cultures of blood, liver abscess drainage fluid, and cerebrospinal fluid all confirmed an infection with Klebsiella pneumoniae. The final diagnosis was “emphysematous osteomyelitis”, and the patient received anti-infective treatment and other supportive therapies, leading to the remission of his condition. Diabetes and malignant tumors are recognized as major risk factors for emphysematous osteomyelitis, while iatrogenic intervention may be a potential predisposing factor in the pathogenesis of the disease. Our report emphasizes the key role of identifying EO through unique imaging features (such as the “pumice stone” sign).