Osteonecrosis and Osteomyelitis of the Proximal Third of Tibia as a Late Sequela of COVID-19: A Case Report.

ABSTRACT

Coronavirus disease was first described as an identified syndrome in December 2019 (COVID-19). Since then, a global pandemic has taken place and the disease has repeatedly been associated with thromboembolic complications, most of which are venous, but may also occur at the arterial level, even in patients receiving thromboprophylaxis. To date, only medium- and large-caliber vessels have been affected by arterial thrombosis secondary to COVID-19. This article describes the case of a 60-year-old woman with a prior severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection who developed multiple bone infarcts, complicated by secondary osteomyelitis. The patient underwent multiple surgical debridements and received a variety of antibiotics before the correct diagnosis was made and a multidisciplinary surgery was planned that provided coverage with a medial gastrocnemius flap. At 5-months follow-up, the patient had recovered well without any clinical evidence of infection or other complications. To the best of our knowledge, this is the first known case of a bone infarct complicated with a secondary osteomyelitis occurring in a patient having suffered a previous SARS-CoV-2 infection. We postulate as our main hypothesis that the prothrombogenic state secondary to SARS-CoV-2 infection may have contributed to thrombosis of small-caliber vessels, in our patient the arteria nutricia tibialis, triggering bone infarcts and a secondary infection with Staphylococcus aureus .