Bilateral severe foot osteomyelitis with polymicrobial infection: A case report

Background: Bilateral severe osteomyelitis in non-diabetic patients represents a complex clinical presentation with high amputation risk. Case presentation: We report a 60-year-old non-diabetic Caucasian male with arterial hypertension and factor V Leiden mutation who developed bilateral severe osteomyelitis. The patient presented with four months of progressive foot ulcers, fever, and limited ambulation. Physical examination revealed massive bilateral lower extremity edema with multiple ulcerations affecting all digits. Laboratory studies showed elevated C-reactive protein (119,5 mg/L) with normal HbA1c. Imaging demonstrated extensive osteolytic changes with complete destruction of multiple phalanges bilaterally. A multidisciplinary approach included two-stage surgical debridement with antibiotic-loaded bead placement, targeted antimicrobial therapy against polymicrobial infection (MSSA, C. striatum), and adjunctive hyperbaric oxygen therapy. Complete healing with functional restoration was achieved at one-year follow-up, allowing return to normal activities including professional work as an orchestra conductor. Conclusion: This case demonstrates that aggressive multidisciplinary management can achieve successful limb salvage even in severe bilateral osteomyelitis with extensive bone destruction in non-diabetic patients, emphasizing the importance of early intervention and coordinated care. 10.1016/j.fuspru.2025.12.005