Emphysematous Osteomyelitis of the Lumbar Spine Masked by a Urinary Tract Infection in a Diabetic Patient: A Case Report

Abstract Background: Emphysematous osteomyelitis (EO) is a rare and aggressive gas-forming bone infection, most commonly affecting diabetic or immunocompromised patients, with the vertebrae, pelvis, and femur being frequently involved sites. It is most often caused by Klebsiella pneumoniae or Escherichia coli via hematogenous spread, and because of its rarity, its diagnosis is frequently overlooked. Case Presentation: We report the case of a 50-year-old diabetic and hypertensive female who presented with dysuria and dull lower back pain, initially managed as a routine UTI with antibiotics and adjustment of her diabetic regimen. When her urinary symptoms failed to resolve, contrast-enhanced CT of the kidneys, ureters, and bladder incidentally revealed emphysematous osteomyelitis of the L3-L4 vertebrae, with urine culture growing Klebsiella species. Despite targeted intravenous antibiotic therapy (meropenem), her clinical response was poor, necessitating anterior corpectomy with cage reconstruction. Her postoperative course was complicated by severe pain and poorly controlled diabetes, and she subsequently died of cardiopulmonary arrest.