Bone marrow edema syndrome of the foot misdiagnosed as infection: Case report

Bone marrow edema syndrome is a rare, self-limited clinical entity of unknown etiology and may be misdiagnosed as an infection. A 62-year-old man developed left foot pain with no prior trauma. Within 2 weeks, he was unable to walk because of increased pain. At 5 weeks, he developed left foot swelling. Radiographs showed midfoot osteopenia. He was treated for presumed gout and infection with nonsteroidal anti-inflammatory drugs, vancomycin, and ceftriaxone but had no improvement. Magnetic resonance imaging showed bone marrow edema and indistinct cortices. Single-photon emission computed tomography–computed tomography and bone scintigraphy showed intense osseous uptake, patchy demineralization, and erosive changes at the left midfoot. The diagnosis of bone marrow edema syndrome was made, based on review of imaging findings and persistent symptoms despite previous treatment. After treatment with analgesics and off-loading devices, he had complete resolution of pain and improvement of midfoot osteopenia by 5 months after symptom onset. In summary, bone marrow edema syndrome in the foot is rare, and awareness of this syndrome is necessary to avoid diagnostic error and unnecessary treatment. If magnetic resonance imaging is not available, single-photon emission computed tomography–computed tomography may be a useful adjunct toward the diagnosis.