Diabetes With Osteomyelitis in Rare Sites With Sepsis as the First Diagnosis: Three Case Reports and Literature Review

Abstract Background : Osteomyelitis is an infectious bone disease. Common clinical symptoms are fever, local limb pain and redness. Anti-infective treatment is commonly used, but the efficacy varies in different patients. Sometimes surgery is needed to relieve patients' symptoms. Diabetic patients have a high risk of osteomyelitis due to long-term hyperglycemia, activated inflammatory response and immune deficiency. Patient Concerns : In our study, the three patients were men who were admitted to the hospital due to fever and pain. Two patients had upper limb pain, and the third had lumbar spine pain. All of them had blood cultures that suggested bacterial infections and increased levels of C-reactive protein. Diagnosis : Two patients in our study had osteomyelitis that was verified by magnetic resonance imaging; osteomyelitis was confirmed by postoperative histopathological examination in the third patient. Interventions : All patients received intravenous infusion of antibiotics to treat osteomyelitis. The third patient underwent debridement of the lumbar spine. Outcomes : Among the three patients, two recovered after adjustment of the antibiotic therapy, and one recovered after a surgical operation. Conclusion : Our study reports three patients with diabetes with osteomyelitis in rare sites. We should be aware that diabetes is one of the risk factors for osteomyelitis. When diabetic patients present with fever and pain, healthcare professionals should be alert to the possibility of osteomyelitis. Blood tests are helpful for clarifying the degree of inflammation, and imaging tests are helpful for locating the infection site. However, for some atypical cases, we cannot rely too much on auxiliary examinations, and we need to pay attention to the clinical symptoms and signs. Glycemic control and anti-infective therapy are common methods for the treatment of osteomyelitis, and surgical intervention should be considered if necessary to relieve local symptoms.