Emphysematous Osteomyelitis of Tibia – A Rare Case Treated with Antibiotic-loaded Absorbable Calcium Sulfate Beads

INTRODUCTION: Emphysematous osteomyelitis (EO) is an uncommon and deadly pathology characterized by occurrence of intraosseus air within the bone. However, only few of them have been reported. The use of local antibiotic delivery system has proven to be very effective in bone and joint infections as they offer decreased hospital stay and early clearance of infection. To the best of our knowledge, there are no reports on local antibiotic delivery using absorbable synthetic calcium sulfate beads in EO. CASE REPORT: A 59-year-old male with Type II diabetes mellitus, chronic kidney, and liver disease came with pain and swelling over left leg. After blood investigations and radiological evaluation, he was diagnosed to have EO of tibia with unknown source of infection. We successfully treated him with immediate surgical decompression and application of antibiotic impregnated absorbable calcium sulfate beads locally for improved local antibiotic delivery. Following this, he was further treated with culture sensitive intravenous antibiotics and his symptoms resolved. CONCLUSION: Early diagnosis and aggressive surgical intervention along with local antimicrobial therapy using calcium sulfate beads can offer better outcome in EO. The local antibiotic delivery system can decrease the use of prolonged intravenous antibiotic therapy and long hospital stay.