Calcaneal osteomyelitis due to fistulization of an ulcerated rheumatoid nodule.
Calcaneal osteomyelitis is uncommon and difficult to treat. Cases due to fistulization of an infected rheumatoid nodule are exceedingly rare.


METHODS
A 65-year-old patient with nodular rheumatoid arthritis (RA) experienced osteomyelitis of the left calcaneus due to inoculation from a fistula draining an ulcerated rheumatoid nodule. Pseudomonas aeruginosa and Enterobacter cloacae were recovered. The conventional treatment of calcaneal osteomyelitis relies on antibiotics and calcanectomy or foot amputation. We used two appropriate antibiotics and monthly intravenous injections of 90 mg of pamidronate.


RESULTS
One year into treatment, the patient was free of pain and the skin wound was fully healed. On a follow-up computed tomography (CT) scan, the fistulous tract was seen to be closed and the large calcaneal defect almost completely filled with new bone.


CONCLUSIONS
Combining two antibiotics and pamidronate may be a viable alternative to excision surgery or amputation in some patients with bone infection carrying a risk of fracture.
Alcaraz
Patrice
P
Rheumatology Department, Pr Roudier, Conception Hospital, Marseille, France.
Aubran
Clémence
C
Jaoua
Sami
S
Roudier
Chantal
C
Mattei
Jean Pierre
JP
Announ
Nadia
N
Chagnaud
Christophe
C
Roudier
Jean
J
Guis
Sandrine
S
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002111:Calcaneus; D017577:Cutaneous Fistula / Q000150:complications*; D004164:Diphosphonates / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D000077268:Pamidronate; D012215:Rheumatic Nodule / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D014456:Ulcer / Q000150:complications*
D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate