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Where is the ankle? Untreated severe chronic osteomyelitis

Teresa Lopes de Magalhães, Marta Nogueira Caldas, Catarina Jorge Gomes.

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A 17-year-old boy, with hereditary sensory and autonomic neuropathy type II, presented to the emergency department with an acute episode of dizziness and blurred vision. He had a history of amputations of distal phalanges of the fingers and toes and had abandoned medical follow-up in the last 3 years. He reported similar episodes of dizziness in the previous week, no history of fever, blood loss, pain, weight loss or other symptoms. Physical examination revealed pallor, normal heart rate and a right plantar ulcer, with necrotic bone exposure and inflammatory signs up to the right ankle. Laboratory testing revealed hemoglobin of 4.3g/dL and C-reactive protein 14,5mg/dL. Computed tomography of the leg revealed endoluminal gas bubbles in the tibia and adjacent soft tissues (Figure 1, arrow), resorption of multiple bones, reflecting osteomyelitis with Charcot foot. After stabilization with blood transfusions and antibiotic therapy, supracondylar amputation of the right leg was performed.

Key words: osteomyelitis, anemia, amputation

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