Massive acute tibial osteomyelitis affter IO catheter insert
Intra-osseous (IO) access is recommended in cases of pre-hospital emergency or resuscitation when intravascular (IV) route is difficult or impossible. Despite recent improvement in IO devices and increasing indications, it remains rarely used in practice. The present case has been reported in the journal BMC Infectious Diseases.

A forty-year-old psychotic and intravenous-drug-addicted male was cared by prehospital service for coma due to drugs overdose. In this emergency situation, without any intravenous access available, an IO device was promptly inserted by the emergency medical technician (EMS) on scene in the upper portion of the left tibia to administer therapeutics and initiate mechanical ventilation.

The IO catheter was removed at Day 1, with report of local inflammation around the insertion site. An erysipelas was diagnosed. Treatment with oral amoxicillin-clavulanic acid (1gx3/day) was introduced. The patient reported psychiatric problems with schizophrenia, multiple intravenous-drug intoxications with coma, and regular cocaine and heroin use. He left the hospital against medical advice three days after IO device removal.

Three months later, he asked for a consultation in the same hospital because of fever and bone pain in the left leg and was hospitalized again. Other complaints were chills and inability to walk normally and to bear weight on his left leg. Redness, warmth, point tenderness and swelling on the site of the IO access were present.

Routine radiographs revealed ill-defined osteolysis of the metaphysis and the epiphysis with a condensed area and blurred periosteal appositions. The magnetic resonance showed important marrow edema with T1-weighted hyposignal and fat-saturated-T2-weighted hypersignal extending in the left tibia, measuring twenty-one centimetres. Soft tissues were infiltrated.

No abscess was visualized but the radiologist could not achieve gadolinium injection because IV access was lacking. MR imaging was compatible with the diagnosis of osteomyelitis.

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