Haematogenous osteomyelitis of the patella. Report of three cases

Patellar Osteomyelitis in a 9-Year-Old Patient with Chronic Granulomatous Disease: A Case Report

Hematogenous osteomyelitis is commonly reported in long tubular bones in the pediatric population. Acute osteomyelitis involving the patella is extremely uncommon in children, and its diagnosis is frequently delayed due to its rarity and variable clinical manifestations. Chronic granulomatous disease (CGD) is a rare genetic immunodeficiency disorder characterized by severe recurrent bacterial and fungal infections. The most commonly affected sites of infection are the lungs, lymph nodes, skin, liver, and gastrointestinal tract. Acute hematogenous osteomyelitis of the patella associated with CGD has never been reported. Our report describes the first case of acute hematogenous patellar osteomyelitis in a pediatric patient with CGD. Her clinical manifestations were similar to other possible differentials such as septic arthritis; however, use of advanced imaging confirmed the diagnosis, and the patient was successfully managed surgically. Since hematogenous osteomyelitis in children is uncommon, a high index of suspicion and advanced imaging may help with its diagnosis, and in cases where antibiotic treatment proves to be insufficient, prompt surgical management is imperative.

Patella Osteomyelitis Mimicking Sinding-Larsen and Johansson Apophysitis: A Pitfall Not to Miss

Background

Diagnosis of bony infection remains difficult during childhood. Osteomyelitis of the patella (OMP) is rare and produces few symptoms and no fever. A high level of suspicion is needed to avoid missing this uncommon type of bone infection.

Methods

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Results

We report an acute osteomyelitis of the patella treated by joint and patella puncture aspiration followed by antibiotics in a 12-year-old healthy boy. Clinical and radiological findings, orthopedic follow-up, and clinical outcome are presented.

Conclusion

Making a diagnosis of acute osteomyelitis of the patella can be challenging especially in the pediatric population, as it produces few specific symptoms with mostly nonspecific biologic anomalies. The paucity in specific signs and symptoms, accompanied by the rare occurrence, often leads to incorrect initial diagnosis, such as overuse injury or apophysitis. Clinical examination with high suspicion for patella infection is key. Radiological exams including MRI are the main components of the adequate imaging studies. Computed tomography may be an excellent addendum to better visualize any bony lesion within the patella. Bone aspiration or biopsy is essential to confirm the diagnosis and offers a first step in the treatment of this infection, which can then be successfully treated with a normal course of antibiotics.

Osteomyelitis of the Patella in a 10-Year-Old Girl: A Case Report and Review of the Literature

The incidence of osteomyelitis constantly declines. While the disease most commonly affects the long bones, involvement of the patella is rarely seen. Due to this rarity and the variable clinical presentation, diagnosis is often delayed. The present case report describes a 10-year-old female patient with a delayed diagnosis of patella osteomyelitis. The diagnostic procedures and the treatment regimen are described. Additionally, a detailed literature review of the available publications reporting osteomyelitis of the patella in children is presented.

Osteomyelitis of the patella: ensure a high index of suspicion and beware the negative aspirate

We report the case of a 33-year-old man who presented several times to healthcare professionals over a 6-week period with a painful swollen right knee. He had a history of chronic osteomyelitis of the left femur and had recently stopped taking suppressive antibiotics. A joint aspirate did not demonstrate any organisms. On subsequent review by the orthopaedic team MRI was performed which revealed an isolated area of osteomyelitis and an abscess in his right patella. He underwent arthrotomy, debridement and irrigation of the joint alongside antibiotic treatment. We highlight this case, as isolated osteomyelitis of the patella is a rare condition, especially in adults. In addition, the presenting features of osteomyelitis of the patella are varied and joint fluid aspirates often do not reveal an organism. This case therefore aims to raise an awareness of this condition and thereby ensure a high index of suspicion when symptoms or signs are present and inform clinicians of the investigative steps in order to avoid a delay in diagnosis as seen in this case.

Hematogenous osteomyelitis of the patella

Osteomyelitis is an uncommon infection that is considered to be a childhood disease. Diagnosis is frequently delayed, as it is a very rare condition and also because of its variable presentation. After an accurate diagnosis and treatment, the outcome is favorable in children. We present one case without recent previous infection, antecedent trauma, or penetrating injury, illustrating the difficulties in diagnosis. Nontraumatic osteomyelitis of the patella should be regarded as a rare hematogenous infection. A high index of suspicion should be addressed for early recognition. Study design is level of evidence: level IV.

Dorsal defect of the patella with fracture in a teenager

We report the case of a young boy who presented a dorsal defect of the patella (DDP) with fracture after a small sport trauma. The patient's parents (professional of health care) had been warned on a possible tumoral disease in a previous consultation and claimed for an accurate diagnosis. Although fracture is rarely reported in DDP, the radiographic image strongly suggested this condition; nevertheless, the diagnosis accuracy requested by the parents lead to indicate a biopsy that showed irregular fragments of laminar bone and hyaline cartilage islands similar to articular cartilage compatible with a non-specific developmental ossification defect. The lytic defect was filled with morselized cancellous bone graft, the fracture having a normal consolidation. With a follow-up of 4 years, the patient is asymptomatic, and the radiological morphology of the patella is normal. Although DDP is accepted to be a radiologically well-defined condition, images may perhaps not get accuracy enough for diagnosis and biopsy may be indicated by clinical and radiological features different than the typical ones. Although fracture is rarely reported in case of DDP, it has not to be considered as indicative of tumor or malignancy.

Patellar osteomyelitis presenting as prepatellar bursitis

Peripatellar lesions causing knee pain include cellulitis, bursitis, synovitis, septic arthritis and patellar osteomyelitis. We present here two cases of patellar osteomyelitis which were misdiagnosed as prepatellar bursitis. Operative treatment was required for these lesions. Patellar osteomyelitis should always be considered when treating a peripatellar lesion, although it is very rare condition.

An unusual case of knee pain

Osteomyelitis of the patella is a rare disease, which primarily affects the pediatric population. We present a case of hematogenous osteomyelitis of the patella with secondary development of septic arthritis of the knee. There is often a delay in diagnosis, as illustrated by our case report, due to the rarity of the condition and nonspecific presentation. There is usually no history of trauma. Focal tenderness over the patella is the most helpful clinical sign. A small joint effusion may be present which is usually sterile and reactionary due to inflammation of the patella. Treatment of osteomyelitis of the patella is similar to treatment of osteomyelitis in other areas. Function and range of motion of the knee usually returns to normal after completion of treatment. A delay in diagnosis may lead to progression of disease and complications such as septic arthritis of the knee.

Osteomyelitis of the patella

Osteomyelitis of the patella is an uncommon infection that is primarily a disease of childhood. The diagnosis frequently is delayed because of its rarity and variable presentation, which may be acute with systemic signs or insidious with mild local signs. The diagnosis should be considered in patients with persistent peripatellar pain and swelling, cellulitis, septic prepatellar bursitis, and septic arthritis of the knee that does not respond to standard treatment. Treatment is identical to the treatment of osteomyelitis at other locations. The outcome is favorable in the child regarding range of motion and activity, although there may be persistent changes radiographically.