Haematogenous vertebral osteomyelitis and septic arthritis of the wrist complicating septic arthritis of the foot in a diabetic patient

Abstract

An elderly female with peripheral diabetic neuropathy presented with a septic arthritis of the left 5th metatarsophalangeal joint. Her condition was further complicated by vertebral osteomyelitis and septic arthritis of the wrist, the latter secondary to the increased local vascularity following a right Colles fracture. Although the plain radiographs of the spine were suggestive of infection, bone scintigraphy was non-specific. MRI appearances at the L3/4 level were classical for infective spondylitis and, following biopsy, culture confirmed an unusual pathogen - Pseudomonas aeruginosa. The organism was also detected on blood culture and in a swab of the foot ulcer some three months previously. Following appropriate antibiotic therapy, the patient made a full recovery.