title: Calcaneal osteomyelitis due to fistulization of an ulcerated rheumatoid nodule.
abstract: 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.
authors.affiliation: Rheumatology Department, Pr Roudier, Conception Hospital, Marseille, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Alcaraz
authors.forename: Clémence
authors.initials: C
authors.lastname: Aubran
authors.forename: Sami
authors.initials: S
authors.lastname: Jaoua
authors.forename: Chantal
authors.initials: C
authors.lastname: Roudier
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Mattei
authors.forename: Nadia
authors.initials: N
authors.lastname: Announ
authors.forename: Christophe
authors.initials: C
authors.lastname: Chagnaud
authors.forename: Jean
authors.initials: J
authors.lastname: Roudier
authors.forename: Sandrine
authors.initials: S
authors.lastname: Guis
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate