PMC7276627_01
Magnetic resonance imaging left elbow shows marrow edema involving the distal humerus, moderate joint effusion, diffuse edema noted in the muscle of elbow joint predominantly the brachialis and the triceps brachii.
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F1
Magnetic resonance imaging (Fig. 1) of left elbow, bilateral knee (Fig. 2 and 3) and right ankle (Fig. 4) show multifocal osteomyelitis.
Magnetic resonance imaging right ankle shows marrow infiltrative diffuse edema noted involving the distal third of tibia extending to its articular surface. Similar changes noted involving the first metatarsal. Diffuse edema noted involving the muscle in myofascial planes of distal leg and entire foot. The fluid is seen within the tendon sheath of tibialis posterior and flexor digitorum longus. Mild joint effusion with synovitis noted.
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Magnetic resonance imaging (Fig. 1) of left elbow, bilateral knee (Fig. 2 and 3) and right ankle (Fig. 4) show multifocal osteomyelitis.
X-ray left elbow anteroposterior and lateral view shows mild subchondral sclerosis of elbow joint, irregular, and thickened distal humerus metaphysis.
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Initial evaluation revealed a normal white cell count (8400 cells/mm3, neutrophils 60%) and elevated inflammatory markers (erythrocyte sedimentation [ESR] rate 113 mm/h, C-reactive protein (CRP) 72 mg/L).X-ray of left elbow revealed distal humerus metaphyseal cortical irregularity and thickening with subchondralsclerosis (Fig. 5).
X-ray bilateral knee with the proximal tibia and distal femur-anteroposterior and lateral view shows mild subchondral sclerosis, distal femur, and proximal tibia metaphyseal thickening and irregularity.
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X-rayof bilateral knee shows proximal tibia and distal femur metaphysis cortical irregularity and thickening (Fig. 6).
X-ray right ankle-Antero-posterior view shows mild subchondral sclerosis, irregular distal tibia metaphysis.
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X-ray right ankle (Fig. 7) shows decrease joint space with mild subchondral sclerosis.
99m technetium 99-methyl diphosphonate whole-body bone scintigraphy along with 3 phase study shows increase uptake in right ankle, left elbow, bilateral knee)
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F8
Technetium 99-MDP whole-body scintigraphy shows increase uptake in left elbow, bilateral knee and right ankle (Fig. 8).
Gram-stain picture showing a black arrow pointing a bipolar stained Burkholderia pseudomallei.
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Gram-negative bacilli, later identified as B. pseudomallei. Gram staining revealed typical bipolar stained B. pseudomallei (Fig. 9).
X-ray left elbow anteroposterior and lateral view 12 months post-operative shows healed lesion of distal humerus metaphysis and elbow joint.
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X-ray bilateral knee anteroposterior and lateral view 12 months post-operative shows healed lesion of the bilateral proximal tibia and distal femur.
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X-ray right ankle anteroposterior and lateral view 12 months post-operative shows healed lesion of the distal tibia.
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Post-operative clinical image shows a healed surgical site with no clinical signs of infection.
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F13
He was well at completion of his eradication therapy with minimal restriction of knee joint range of movements. His clinical picture (Fig. 13) shows complete healing with no sign of residual infection (redness, discharging sinus, and swelling).