Charcot Neuropathic Osteoarthropathy Imitating Osteomyelitis; Case Report and Brief Review of the Literature

Abstract

Charcot neuropathic osteoarthropathy (CN) is a chronic progressive disease that affects foot and ankle bone commonly. Osteoarticular deformities and functional disability may develop in the affected bone and joints. Various diseases may play role in the etiology. The most common causes are tabes dorsalis, leprosy, syringomyelia, diabetes mellitus, myelomeningocele, spinal cord trauma, tumors, poliomyelitis, Riley-oayer syndrome, cystic bone disease, congenital pain, loss, progressive feeling neuropathy, amyloid neuropathy, progressive muscular atrophy, cerebral hemorrhage after hemiplegia, druds such as thalidomide. Clinical findings are joint instability, soft tissue calcifications, misshapen and deformed joint appearance. There is no joint tenderness. Treatment of CN is the treatment of primary disease.  In this case report we present a 59 years old women with CN. She had a poor glycemic control. The diagnosis was based on foot radiography and magnetic resonance imaging (MRI) findings. Edema and widespread destruction in the bone, joints and surrounding soft tissue can be seen in MRI. Firstly, osteomyelitis was considered in this patient and  this situation had led to delays in diagnosis and unnecessary drug use. In conclusion, if there is doubt in the diagnosis of foot lesions in diabetic neuropathic patients for preventing the development of foot deformities and avoiding longterm unnecessary antibiotic use; multidisciplinary approaches should be applied.