Diagnosis and Treatment of Suspected Osteomyelitis in a Complex Patient: A Case Report

Osteomyelitis is a devastating bone infection that occurs in individuals usually with significant comorbidities. This disease may lead to further major medical problems if not diagnosed and treated promptly. This case involves a 51-year-old male with multiple comorbidities, which led to the diagnosis of suspected chronic osteomyelitis. Laboratory work showed leukocytosis, decreased kidney function, anemia of unknown origin, and physical examination showing multiple skin ulcers. CT imaging supported the diagnosis of suspected chronic osteomyelitis. Due to the limited standard diagnostic testing modalities for osteomyelitis, significant clinical judgment had to be used and applied to treat osteomyelitis in this case. These diagnostic limitations included the absence of MRI evaluation, bone biopsy and subsequent histopathologic examination, as well as wound culture data. The antimicrobial drug use was influenced by the patient's underlying chronic kidney disease, which influenced treatment with cefepime and doxycycline rather than vancomycin. This case highlights the complexity of diagnosing and treating medically complex patients, with limited definitive diagnostic modalities, such as bone histopathology, wound cultures, and imaging, thus relying on clinical decision-making to formulate treatment options.