X-ray Findings in a Case of Acute Osteomyelitis Following Puncture Injury: A Case Report

Puncture wounds are common injuries that may lead to infection. Diabetic patients are at higher risk for serious infections, including osteomyelitis. Osteomyelitis is an infection of the bone that requires a combination of surgical and antibiotic therapy. X-ray findings of osteomyelitis include demineralization, periosteal reaction, and bony destruction. This case follows a 62-year-old woman with a history of uncontrolled type 2 diabetes mellitus who presented to the emergency department (ED) for left foot pain after she stepped on a nail that punctured her foot through her shoe. Four days before presentation, she was evaluated at an outside ED and prescribed cephalexin for foot cellulitis. She returned to the ED with worsening foot pain and swelling despite compliance with cephalexin. A foot X-ray was obtained and demonstrated evidence of acute osteomyelitis. The diagnosis was confirmed with magnetic resonance imaging and, ultimately, a bone biopsy. The patient received intravenous antibiotics and surgical ray amputation. At follow-up, she showed clinical improvement, with notable wound healing and reduced symptoms. The primary takeaways from this case are the importance of considering expanding workups for patients who return to the ED and that X-rays can provide important diagnostic information for acute osteomyelitis, despite not having a high sensitivity.