Presentation
Peripheral vascular disease. Necrotic foot ulcers.
Patient Data
Gas under the nails and around the bones of the 1st to 3rd toes.
Deficient soft tissue and overlying dressings.
Emphysematous osteomyelitis of the distal phalanx of the hallux and the distal and middle phalanges of the second and third toes with gas under the nails and within and around the bones. Focal cortical thinning most apparent in the 2nd digit.
Small pockets of gas along the dorsal soft tissue of the proximal forefoot and medial aspect of the mid foot suggest necrotising soft tissue infection.
Case Discussion
Gadolinium enhanced MRI was performed to delineate areas of necrosis that would be inaccessible to antibiotics and require amputation, however the images were unhelpful due to motion artefact.
Swabs were taken from the ulcerated areas:
Gram Stain: few Polymorphs, 1+ Gram negative rods, culture: 1+ Pseudomonas aeruginosa 1+ Citrobacter freundii.
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