PMC9852681_01
Abnormal T1-weighted STIR bone marrow signal involving the first digit extending into the middle phalanx, with additional abnormal bone marrow edema within the middle second and third phalanges, and abnormal bone marrow signal in the middle fourth phalange, as indicated by red arrows. (Left foot Magnetic Resonance Imaging, axial view).
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Magnetic Resonance Imaging (MRI) of the left foot demonstrated acute multi-focal osteomyelitis involving the distal first and fourth phalanges, as well as the middle second and third phalanges (Fig. 1).
Abundant acid-fast bacilli visualized with fluorescence microscopy of resected bone (auramine-rhodamine stain, original magnification x1000).
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Pathology of bone specimens revealed residual acute osteomyelitis at the resection margins and abundant acid-fast bacilli on auramine-rhodamine fluorochrome stains of all specimens (Fig. 2).
Heavy burden of slim, rod-shaped bacteria within operative bone specimen, as indicated by red arrows. (Ziehl-Neelsen stain, original magnification x1000).
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The patient underwent completion left trans-metatarsal amputation which demonstrated heavy bacterial burden within the resected bone (Fig. 3).