Osteomyelitis of the head of the first metatarsal bone

Case contributed by Dr Bruno Di Muzio

Presentation

Erythema, pain, and swelling on the left hallux.

Patient Data

Age: 77-year-old
Gender: Female
X-ray

Forefoot radiographs

Hallux valgus and claw toes deformity. Soft tissue swelling over the medial aspect of the first metatarsophalangeal joint. No bony erosions or soft tissue calcification to suggest gout. No definitive evidences od osteomyelitis. 

Marrow oedema and patchy subcortical enhancement at the dorsomedial aspect of the head of the first metatarsal bone. Subcutaneous enhancement and oedema overlying this region. No evidence of subcutaneous collections to suggest abscess. There is a moderate 1st MTP joint effusion. No sesamoid oedema or enhancement. Hallux valgus deformity. Bone marrow and joint spaces are otherwise unremarkable. No evidence of fractures. 

Case Discussion

MRI was consistent with early changes of osteomyelitis of the head of the first metatarsal bone.

Aspiration was performed: 

Specimen Type : Synovial Fluid

CRYSTAL EXAMINATION (POLARIZATION MICROSCOPY): Sodium Urate Crystals NOT Detected Calcium Pyrophosphate Crystals NOT Detected

GRAM STAIN Leucocytes +++ Epithelial Cells + Gram-positive cocci +

CULTURE 1. Staphylococcus aureus +++

SENSITIVITIES 1 Clindamycin S Cotrimoxazole S Erythromycin S Fusidic Acid S Oxacillin S Penicillin R Rifampicin S Vancomycin S

 

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Case information

rID: 48372
Case created: 3rd Oct 2016
Last edited: 6th Nov 2016
Tag: rmh
Inclusion in quiz mode: Included

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