Humeral Osteomyelitis due toStaphylococcal aureus Infection as the Initial Presentation of Diabetes Mellitus

Cho-Ok Baek; Ki Hoi Kim; Sun Kyung Song; Jong Myoung Lee; Ji Hye Kim

doi:10.4093/jkd.2015.16.3.218

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Baek, Kim, Song, Lee, and Kim: Humeral Osteomyelitis due toStaphylococcal aureus Infection as the Initial Presentation of Diabetes Mellitus

Case Report

J Korean Diabetes 2015;16(3):218-224.

Published online: 10 January 2015

DOI: https://doi.org/10.4093/jkd.2015.16.3.218

Humeral Osteomyelitis due toStaphylococcal aureus Infection as the Initial Presentation of Diabetes Mellitus

Cho-Ok Baek¹, Ki Hoi Kim¹, Sun Kyung Song¹, Jong Myoung Lee², Ji Hye Kim¹

¹Departments of Internal Medicine Presbyterian Medical Center, Jeonju, Korea

²Departments of Orthopedics, Presbyterian Medical Center, Jeonju, Korea

Corresponding author: Ji Hye Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju 54987, Korea, E-mail: wisdom0165@gmail.com

Received 14 February 2015 Revised 27 February 2015 Accepted 31 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetes mellitus is a common disorder and presents in different ways. Shoulder pain is a common musculoskeletal complaint, especially in middle-aged or older-aged men. While it is widely accepted that diabetics have an increased propensity to develop infections, a diagnosis of osteomyelitis of the humerus as the etiology of constant shoulder pain might be delayed, as occurred in this case study, until patients’ develop clear signs of infection. Here, we describe a case of subacute osteomyelitis as the first physical symptom of diabetes; the possibility of osteomyelitis should therefore be investigated in all patients with diabetes mellitus who develop joint or bone-related pain.

Keywords: Diabetes mellitus, Humerus, Osteomyelitis

References

1. Smith CR, Binder AI, Paice EW. Lesions of the midshaft of the humerus presenting as shoulder capsulitis. Br J Rheumatol. 1990; 29:386–8.

2. Kay NRM. The painful shoulder: diagnosis and management. Rheumatol Pract. 1989; 6:20–7.

3. Calhoun JH, Manring MM, Shirtliff M. Osteomyelitis of the long bones. Semin Plast Surg. 2009; 23:59–72.

4. Arkkila PE, Kantola IM, Viikari JS, Rönnemaa T. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis. 1996; 55:907–14.

5. Hamdy RC, Lawton L, Carey T, Wiley J, Marton D. Subacute hematogenous osteomyelitis: are biopsy and surgery always indicated? J Pediatr Orthop. 1996; 16:220–3.

6. Olasinde AA, Oluwadiya KS, Adegbehingbe OO. Treatment of Brodie's abscess: excellent results from curettage, bone grafting and antibiotics. Singapore Med J. 2011; 52:436–9.

7. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med. 1997; 14:29–34.

8. Llorente L, De La Fuente H, Richaud-Patin Y, Alvarado-De La Barrera C, Diaz-Borjón A, López-Ponce A, Lerman-Garber I, Jakez-Ocampo J. Innate immune response mechanisms in non-insulin dependent diabetes mellitus patients assessed by flow cytoenzymology. Immunol Lett. 2000; 74:239–44.

9. Graham PL 3rd, Lin SX, Larson EL. A U.S. population-based survey of Staphylococcus aureus colonization. Ann Intern Med. 2006; 144:318–25.

10. Ross ER, Cole WG. Treatment of subacute osteomyelitis in childhood. J Bone Joint Surg Br. 1985; 67:443–8.

11. Jones NS, Anderson DJ, Stiles PJ. Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis. J Bone Joint Surg Br. 1987; 69:779–83.

12. Rasool MN. Primary subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br. 2001; 83:93–8.

13. Cole WG. The management of chronic osteomyelitis. Clin Orthop Relat Res. 1991; 264:84–9.

14. Boucher H, Miller LG, Razonable RR. Serious infections caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2010; 51(Suppl 2):S183–97.

Fig. 1.

(A) Simple x-ray of the shoulder showed near normal findings except for a small bone spur at the glenoid of the scapula and an incidental mid-humeral osteolytic lesion that was missed upon first examination (arrow). (B) The bone scan showed significantly increased uptake in the mid-shaft of the left humerus. (C) Fat-saturated contrast-enhanced T1 weighted magnetic resonance imaging (sagittal view) revealed Brodie's abscess formation in the proximal 1/3 and mid-shaft of the left humerus accompanied by diffuse bone marrow signal change and adjacent soft tissue swelling with juxtacortical abscess formation.

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