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OBJECTIVE: Emphysematous osteomyelitis is caused by gas forming organisms and is characterized by intraosseous gas presence. It is an extremely rare infection with significant morbidity and mortality. CASE PRESENTATION: We present a case of a 58-year-old female with uncontrolled diabetes mellitus, with emphysematous osteomyelitis of sternum and clavicle due to Escherichia coli. CONCLUSIONS: Early diagnosis, prompt broad spectrum antibiotic therapy and aggressive surgical intervention are essential to improve the outcome in these cases.