PMC8267561_01
Skin changes and draining sinus associated with chronic A. xylosoxidans osteomyelitis of the right femur.
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His right thigh was swollen, with overlying scaly skin discoloration and a 2 mm draining sinus on the posterolateral aspect of the distal thigh (Fig. 1).
Pre-operative fat-suppressed T2 magnetic resonance images. a) Coronal image of bilateral thighs demonstrating medial and lateral thigh collections, an inferior intramedullary collection and myositis of the vastus intermedius muscle. b) Sagittal image of the right thigh demonstrating superior and inferior intramedullary collections. c) Axial image of the right thigh demonstrating a posteromedial draining sinus tract. d) Axial image of the right thigh demonstrating an anteromedial draining sinus tract and medial and lateral thigh collections.
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Further evaluation was undertaken with magnetic resonance imaging (MRI) which revealed radiological findings suggestive of COM of the right femur with extensive intramedullary, cortical and surrounding soft tissue involvement (Fig. 2).
Antero-posterior plain radiograph of the right femur 12 months post-operatively showing bony remodelling and cortical thickening.
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At this stage, a follow-up plain radiograph of the affected femur showed no residual disease (Fig. 3).