• Sahyun Sung, Byung Ho Lee, Jung-Hwan Kim, Yung Park, Joong Won Ha, Seong-Hwan Moon, Hwan-Mo Lee, and Ji-Won Kwon.
• Department of Orthopedic Surgery, Yonsei University College of Medicine.
• Medicine (Baltimore). 2020 Jul 10; 99 (28): e21113.

RationaleEmphysematous osteomyelitis is a rare disease caused by gas-forming bacteria. But only 45 cases have been reported in the literature since then.Patient ConcernsA 72-year-old female presented to our hospital with severe lower back pain that aggravated 4 days ago.DiagnosesComputed tomography (CT) revealed intraosseous mottled air in the T12 and L1 vertebral bodies and epidural space. The enhanced T1 and T2 magnetic resonance imaging scans showed heterogeneous signal intensity of vertebral bodies, suggestive of emphysematous osteomyelitis.InterventionsSurgery was performed to identify culture strains and to remove emphysematous lesions of the vertebral body using extensive transpedicular irrigation.OutcomesEscherichia coli (E coli) was identified in the surgical specimen, and intravenous antibiotic therapy was continued with cefotaxime. The patient had a significant decrease in lower back pain after the surgery and the final CT scan before discharge revealed significantly decreased air at T12 and L1 vertebral bodies and no air density in the epidural space.LessonsWe present a patient diagnosed with emphysematous osteomyelitis in vertebral bodies caused by E coli and successfully treated with surgical intervention.

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