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Case Report
Unique case study of HbS-β* thalassemia presenting as multifocal emphysematous osteomyelitis and life-threatening E. coli septicemia
1 Manager, Academics and Research, Fortis Memorial Research Institute, Gurgaon 122002, India
2 MBBS, DNB Resident, Fortis Memorial Research Institute, Gurgaon 122002, India
3 Associate Consultant, Paediatric Haematology Oncology & BMT Fortis Memorial Research Institute, Gurgaon 122002, India
4 Consultant, Infectious Disease, Fortis Memorial Research Institute, Gurgaon 122002, India
5 Consultant, Radiology, Fortis Memorial Research Institute, Gurgaon 122002, India
6 Senior Director & Unit Head, Internal Medicine, Fortis Memorial Research Institute, Gurgaon 122002, India
Address correspondence to:
Yogita Singh
Head, Academics and Research, Fortis Memorial Research Institute, Gurgaon 122002,
India
Message to Corresponding Author
Article ID: 101525Z01YS2025
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Singh Y, Jaiswal A, Kumar NM, Rastogi N, Mehta L, Parti A. Unique case study of HbS-β* thalassemia presenting as multifocal emphysematous osteomyelitis and life-threatening E. coli septicemia. Int J Case Rep Images 2025;16(2):69–72.ABSTRACT
Introduction: Sickle beta-thalassemia (S/β-thalassemia) is a compound heterozygous hemoglobinopathy with clinical manifestations influenced by the type of beta-thalassemia gene inherited. Sickle beta-thalassemia has a variable prevalence globally, ranging from 0.1% to 0.3% in certain Indian populations and higher rates in Mediterranean and African regions. Although osteomyelitis is a known complication in hemoglobinopathies, emphysematous osteomyelitis (EO)—a gas-forming, life-threatening infection—is exceptionally rare, particularly with Escherichia coli as the causative organism.
Case Report: Emphysematous Osteomyelitis commonly presents with localized bone pain, swelling, high-grade fever, and signs of systemic sepsis. Imaging typically reveals gas within the bone. A 32-year-old Asian male with a known history of sickle β-thalassemia major presented with high-grade fever, abdominal pain, and back pain. Previously treated for E. coli septicemia and subacute appendicitis, he showed persistent symptoms despite antibiotics. Imaging revealed multifocal EO involving the clavicles, sacrum, and shoulder joint. Bone biopsy confirmed E. coli infection. Hemoglobin electrophoresis (HPLC) confirmed sickle β-thalassemia major. Management included broad-spectrum intravenous (IV) antibiotics (imipenem, teicoplanin, polymyxin B), empirical antifungal therapy, hydroxyurea, and red blood cell exchange transfusion to reduce HbS below 30%. The patient showed clinical improvement and was discharged with a 6-week antibiotic regimen.
Conclusion: This is the first documented case of multifocal E. coli-induced emphysematous osteomyelitis in a patient with sickle β-thalassemia major. The case underscores the importance of early diagnosis through magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT), aggressive antimicrobial therapy, and hematologic optimization via exchange transfusion. Clinicians should consider atypical pathogens like E. coli in hemoglobinopathy-related infections for timely and effective intervention.
Keywords: Emphysematous osteomyelitis, E. coli, Hemoglobinopathy, Magnetic resonance imaging, Musculoskeletal radiology, PET-CT, Sickle beta-thalassemia
SUPPORTING INFORMATION
Author Contributions
Yogita Singh - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Akhilesh Jaiswal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nikhil M Kumar - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Neha Rastogi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lakshay Mehta - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Amitabh Parti - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Yogita Singh et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
