Osteomyelitis in Hemodialysis Patients

Five patients receiving regular hemodialysis developed osteomyelitis. Rib and thoracic vertebral column were the most common sites of involvement. The diagnosis was made ante mortem in four and discovered at autopsy in one patient. Osteomyelitis masqueraded as podagra, bacterial endocarditis, renal osteodystrophy, and fever of unknown origin. Three patients were considered cured, but only two lived. Surgical intervention was necessary to establish the diagnosis and to definitively treat four patients. Repeated access to the circulation, particularly when associated with indwelling cannulas, is the most important determinant of infection. Diabetes mellitus, chronic pulmonary disease, and adrenocorticosteroid therapy may be contributory causes.