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Citrobacter koseri causing osteomyelitis in a diabetic foot with concomitant acute gouty arthritis successfully treated with ertapenem
  1. Dillon Tinevez1 and
  2. Nebojsa Nick Knezevic1,2
  1. 1 Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
  2. 2 Anesthesiology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Nebojsa Nick Knezevic, nick.knezevic{at}


We present an elderly diabetic man with left hallux pain and drainage who was initially diagnosed with acute gouty arthritis using the diagnostic rule for acute gout and monosodium urate crystals presented on synovial fluid analysis. Further investigation with surgical debridement, plain X-ray, MRI and wound culture revealed concomitant Citrobacter koseri septic arthritis with osteomyelitis. C. koseri is considered an opportunistic infection that rarely causes musculoskeletal infections. Acute gouty arthritis and septic arthritis are rarely seen occurring concomitantly in the same joint and are often difficult to differentiate due to similar findings on exam and imaging. The present case illustrates that osteomyelitis with an opportunistic organism can present concomitantly with acute gouty arthritis, and the diagnosis of one should not exclude the other.

  • infections
  • musculoskeletal and joint disorders
  • diabetes
  • pain

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  • Contributors DT took care of the patient and wrote the manuscript. NNK contributed to the writing and reviewing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.