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This is the case of a 43-year-old wheelchair-user man with a history of hepatitis C, cirrhosis, intravenous drug abuse and a 2-year history of chronic right lower extremity ulcers who presented to the emergency department with 4 days of worsening right leg pain. On physical exam, there was a new area of fluctuance on the anterior tibial surface. Labs included a white cell count of 9.3 K/µL, C reactive protein of 129 mg/L and erythrocyte sedimentation rate of 90 mm/hour. A CT scan demonstrated proximal tibia osteomyelitis with an intramedullary abscess, surrounding soft tissue abscesses and septic arthritis of the knee joint (figure 1).
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