Background: Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to [...]

Background: Osteomyelitis is an acute or chronic infection of the bone structures which can be caused by either bacteria, fungi, or mycobacteria. Studies have reported a high annual incident of about 1 in 675 hospital admission in the United States. The overall incident is higher in the male population for reasons unclear and increases with [...]

Background: Diagnostic MR imaging of osteomyelitis in the hospital setting continues to guide patient care and treatment when plain films are inconclusive. However, even MRI with gadolinium can be non-specific in patients with other forms of sterile inflammation, leading to overtreatment in the form of invasive procedures and lengthy antibiotic regimens. Ferumoxytol is an iron [...]

Case Presentation: A 76-year-old man with bladder cancer presented with severe back pain and radiculopathy after receiving treatment with a transurethral resection and subsequent intravesical BCG therapy. His lumbar MRI showed degenerative and morphological changes suggestive of an infection (Figure 1). He was treated with L1-L5 laminectomies and foraminotomies. 3 weeks later, repeat imaging showed [...]

Case Presentation: A 64-year-old woman with uncontrolled type 2 diabetes mellitus presented with five months of constant, stabbing left temporal headache radiating to the ear, jaw, and neck. She had associated progressive neurologic deficits, including blurred vision, flashing lights, and subacute left-sided hearing loss. She had presented to another hospital two months prior to the [...]

Case Presentation: A 67-year-old man with a history of previously treated prostate cancer presented with two weeks of low back pain. The pain had progressed and was now associated with bilateral lower extremity shooting pain and weakness. He denied bowel or bladder incontinence or saddle anesthesia. He was found to be afebrile with normal vital signs, poor dental [...]

Case Presentation: Bacterial osteomyelitis is very challenging to treat. This is partly due to the widespread antimicrobial resistance to gram positive bacterium Staphylococcus Aureus. We present a severe case of disseminated staphylococcus aureus osteomyelitis, that includes bacteriemia, psoas abscess, infective endocarditis, osteomyelitis, septic arthritis of knee and shoulder joints. A 63-year-old woman with poorly controlled [...]

Case Presentation: An 82-year-old, Samoan male with history of poorly controlled diabetes, hypertension, COPD, and pulmonary coccidioidomycosis on fluconazole therapy (400 mg/day) was referred to the hospital by his primary doctor for treatment of a left ankle ulcer and cellulitis that had not responded to ten days of outpatient amoxicillin-clavulanate therapy. He had no constitutional [...]

Case Presentation: A 70-year-old man with a history of bladder cancer treated with intravesical Bacillus Calmette-Guerin (BCG) therapy presented with acute on chronic back pain. Six months prior, he presented with lower back pain, was diagnosed with culture negative bacterial osteomyelitis, and underwent an L3-L5 laminectomy. He was discharged with an empiric 6-week antibiotic course [...]

Case Presentation: An 86-year-old male with a past medical history of bladder cancer, status post Bacillus Calmette-Guerin (BCG) therapy 12 months prior, presented to the ED with three months of progressively worsening back pain and weight loss. He denied cough, fever, night sweats, dysuria, recent travel, history of farming, exposure to cattle, or consumption of [...]