Emphysematous Osteomyelitis of the Spine due to Staphylococcus aureus

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We report a case of emphysematous osteomyelitis of the spine secondary to methicillin- susceptible Staphylococcus aureus (MSSA) bacteremia. A 70-year-old man with type 2 diabetes and diabetic renal failure presented with fever and swelling of the right lower extremity. He was admitted to the hospital after being diagnosed with acute cellulitis originating from an ulcer on the right thumb. MSSA was detected in blood culture, and cefazolin was administered. On the 12th hospitalization day, the patient complained of lumbar pain. Physical examination revealed tenderness of the lumbar spinous process. Plain computed tomography (CT) revealed gas around the fifth lumbar vertebral body (L5) and epidural area. Magnetic resonance imaging (MRI) showed edematous changes in the vertebral bodies and surrounding soft tissues at the L5/S1 level. The patient was diagnosed with emphysematous osteomyelitis of the spine. Antibiotic therapy was continued, and CT after almost 4 months of treatment revealed the disappearance of emphysema. Subsequently, the treatment was terminated. Emphysematous osteomyelitis of the spine has a presentation similar to pyogenic spondylitis;however, it has a high mortality rate and requires prompt diagnosis. Diagnosing emphysematous osteomyelitis might require both CT and MRI. In addition to gram-negative rods and anaerobes, MSSA may also be a causative agent.