A Rare Case of Rib Osteomyelitis in an Intravenous Drug Abuser

Osteomyelitis (OM) is one of the most common invasive bacterial infections. Rib osteomyelitis is a rare disease that occurs in ~1% or less of all osteomyelitis. It can result from direct inoculation from traumatic wounds, by spreading from adjacent tissue affected by cellulitis or septic arthritis, or through hematogenous seeding. We present a case of a 32-year-old female with a history of Intravenous drug abuse who presented with localized left-sided chest pain. A CT thorax contrast study was obtained that showed edema around the anterior aspects of the left 3rd to fifth ribs and involves the inferior border of the pectoralis muscle with buckling of the left 4th rib with fluid density in the fascial planes. Subsequently, an MRI was done that revealed the pathological fracture of the anterior aspect of the left forth rib with evidence of osteomyelitis of the left 4th and 5th ribs, as well as early insufficiency fracture of the left fifth rib. Blood cultures were negative. She was treated conservatively with empiric antibiotics due to lack of seeding and bacteremia.