Citrobacter koseri causing osteomyelitis in a diabetic foot with concomitant acute gouty arthritis successfully treated with ertapenem. Issue 7 (27th July 2019)

• Record Type: Journal Article
• Authors: Tinevez, Dillon; Knezevic, Nebojsa Nick
• Is Part Of: BMJ case reports. Volume 12:Issue 7(2019)
• Publication Date: 2019-07-27
• Subjects: infections -- musculoskeletal and joint disorders -- diabetes -- pain; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-230432
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : We present an elderly diabetic man with left hallux pain and drainage who was initially diagnosed with acute gouty arthritis using the diagnostic rule for acute gout and monosodium urate crystals presented on synovial fluid analysis. Further investigation with surgical debridement, plain X-ray, MRI and wound culture revealed concomitant Citrobacter koseri septic arthritis with osteomyelitis. C. koseri is considered an opportunistic infection that rarely causes musculoskeletal infections. Acute gouty arthritis and septic arthritis are rarely seen occurring concomitantly in the same joint and are often difficult to differentiate due to similar findings on exam and imaging. The present case illustrates that osteomyelitis with an opportunistic organism can present concomitantly with acute gouty arthritis, and the diagnosis of one should not exclude the other.