Brodie's Abscess: A Systematic Review of Reported Cases

Brodie's abscess of the calcaneus due to Serratia marcescens

Brodie's abscess is a subacute or chronic osteomyelitis characterised by an intraosseous abscess. It may present months to years after the inciting event. Staphylococcus aureus is the most common causative organism of Brodie's abscess, while Gram-negative bacteria are uncommon causative organisms. A combination of culture-directed antibiotics and surgical debridement is key to successful management. This case report describes a patient with a history of minor trauma preceding the development of Brodie's abscess of the calcaneus caused by Serratia marcescens This was managed successfully with surgical debridement, followed by oral antibiotics.

Brodie's Abscess of the Humeral Paddle in a Child: A case Report

Introduction

Brodie's abscess is a form of localized sub-acute osteomyelitis that rarely occurs in the humerus. Its diagnosis stems from clinical, laboratory, and imaging findings, especially magnetic resonance imaging (MRI). The current paper describes the first case in the literature of humeral paddle Brodie's abscess.

Case Report

This report describes the first case of Brodie's abscess in the humeral paddle of a 12-year-old boy, revealed by swelling and pain in the right elbow. Radiographs and computerized tomography (CT) scans showed a well-defined cavitary surrounded by a rim of sclerosis, alongside evidence of cortical expansion and periosteal reaction. The patient was treated with debridement and curettage of the cavity combined with antibiotics. They resulted in the complete disappearance of the cavity. After 1 year of follow-up, the patient can practice daily activities with no pain, and imaging showed no signs of recurrence.

Conclusion

The present case highlights the utility of CT scans in diagnosing Brodie's abscesses when an MRI is either unavailable or contraindicated. CT scans serve as a valuable alternative diagnostic modality in such cases.

Imaging of MSK infections in the ER

Musculoskeletal infections in the ER are not an uncommon presentation. The clinical context is critical in determining the suspicion for infection and degree of tissue involvement which can involve all layers from the skin to bones. The location, extent, and severity of clinically suspected infection directly relate to the type of imaging performed. Uncomplicated cellulitis typically does not require any imaging. Localized and superficial infections can mostly be evaluated with ultrasound. If there is a diffuse site (an entire extremity) or suspected deeper involvement (muscle/deep fascia), then CT is accurate in diagnosing, widely available, and performed quickly. With potential osseous involvement, MRI is the gold standard for diagnosing acute osteomyelitis; however, it has the drawbacks of longer scan times, artifacts including patient motion, and limited availability.

Lumbar laminectomy and washout of emphysematous osteomyelitis infection of the spine: illustrative case

BACKGROUND

Emphysematous osteomyelitis (EO) is a rare, rapidly progressing infection characterized by gas within bones, leading to severe morbidity if untreated. In the spine, EO can cause significant bone destruction and instability, requiring urgent surgical and medical intervention. Early diagnosis and a multidisciplinary approach are crucial for effective management and improved patient outcomes.

OBSERVATIONS

The authors present a unique case of EO involving the lumbar spine in a 40-year-old male patient with a medical history of diabetes mellitus, hyperlipidemia, and hypertension. Magnetic resonance imaging and computed tomography revealed the formation of gas within the L4 vertebral body and spinal canal, which led to the diagnosis of EO. Blood cultures grew Streptococcus dysgalactiae. The patient underwent laminectomy, discectomy, and vertebral body abscess washout to prevent further spread of the infection and successfully recovered.

LESSONS

The authors report the first case of spinal EO caused by S. dysgalactiae, treated using laminectomy with debridement of the affected disc spaces. https://thejns.org/doi/10.3171/CASE24434.

Spontaneous Osteomyelitis and Intraosseous Abscess: A Case Report

Introduction

Acute hematogenous osteomyelitis may have significant morbidity and mortality if undiagnosed. Because it is uncommon in developed countries and has variable presentations, the patient may undergo several healthcare visits prior to diagnosis.

Case Report

We report the case of a 9-year-old male who presented with hip and knee pain with associated fevers and was found to have osteomyelitis and intraosseous abscess in the diaphysis of the right femur. He had multiple emergency department and outpatient visits before the ultimate diagnosis was made. He was treated with irrigation and debridement in addition to intravenous antibiotics.

Conclusion

Pediatric acute hematogenous osteomyelitis can have subtle presentations, and this case illustrates some of the difficulties in making the diagnosis. This condition should be considered in the workup of a child with undifferentiated fever, pain, or decrease in mobility.

Brodie's abscess as a late complication of external fixation of the distal radius: A case report

CASE

A 41-year-old male presented with an insidious onset of pain and swelling about the dorsal wrist, and was found to have a Brodie's abscess in the distal radius. The patient had a history of a distal radius fracture, treated with external fixation, nineteen years prior, which we believe contributed to the infection. The patient was treated surgically with abscess irrigation, debridement, bony curettage, bioactive glass S53P4 allograft, with concurrent antibiotic therapy.

CONCLUSION

Brodie's abscesses can have atypical presentations, and a thorough history must be obtained from patients to identify any potential sources of infection.

Neoplastic and Non-neoplastic Bone Lesions of the Knee

Numerous anatomical variants are described around the knee, many of which look like bony lesions, so it is important to know them to avoid unnecessary complementary tests and inadequate management. Likewise, several alterations in relation to normal development can also simulate bone lesions.However, numerous pathologic processes frequently affect the knee, including traumatic, inflammatory, infectious, and tumor pathology. Many of these entities show typical radiologic features that facilitate their diagnosis. In other cases, a correct differential diagnosis is necessary for proper clinical management.Despite the availability of increasingly advanced imaging techniques, plain radiography is still the technique of choice in the initial study of many of these pathologies. This article reviews the radiologic characteristics of tumor and nontumor lesions that may appear around the knee to make a correct diagnosis and avoid unnecessary complementary radiologic examinations and inadequate clinical management.

[Imaging Findings in Pediatric Musculoskeletal Infection and Inflammation]

Infections and inflammatory conditions of immature musculoskeletal systems in pediatric patients also affect the adjacent muscles, connective tissues, and joints. Rapid diagnosis leading to appropriate treatment can significantly impact the occurrence of complications and mortality rates due to these conditions. When a radiologist becomes familiar with the imaging findings of pediatric musculoskeletal infections and inflammatory diseases, rapid differential diagnoses and more timely and appropirate treatment could be possible. In this paper, we introduce the imaging findings of infectious and inflammatory diseases affecting the immature musculoskeletal system, such as osteomyelitis, pyogenic arthritis, juvenile idiopathic arthritis, and hemophilic arthritis, based on the anatomical and pathophysiological characteristics of the immature musculoskeletal system in children.

An unusual case of Brodie's abscess in the humerus of an adult female

Brodie's abscess is a manifestation of subacute to chronic osteomyelitis, characterized as intraosseous abscess formation, usually on the metaphysis of the long tubular bones in the lower extremities of male pediatric patients. Clinically, Brodie's abscess presents with atraumatic bone pain of an insidious onset, with absence of systemic findings. Delay in diagnosis is common, as diagnostic imaging, followed by biopsy for culture and histologic examination are generally required to secure a diagnosis of Brodie's abscess. Treatment of Brodie's abscess is non-standardized, and usually consists of surgical debridement and antibacterial therapy. Despite the variability in therapeutic approaches, outcomes of Brodie's abscess treated with surgery and antibiotics are favourable. Herein we report a case of a delayed diagnosis of Brodie's abscess in the upper extremity of an adult female. While she improved with treatment of Brodie's abscess, the case serves to remind clinicians to consider this entity in adult individuals who present with atraumatic bone pain.

Current updates in MSK infection imaging: A narrative review

This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.

Pediatric Hip Pain with Bone Lesion, Sepsis, and Occam's Razor = Brodie's Abscess Case Report

Introduction

Brodie's abscess is one type of subacute osteomyelitis that can be difficult to diagnose because characteristic signs and symptoms can be subtle and non-specific. Up to 90% of Brodie's abscess cases are initially misdiagnosed, with a mean delay of 3 months to the correct diagnosis, with 50% of them misdiagnosed as tumors. Other conditions can also present quite similarly.

Case Report

A 7-year-old male presented with complaints of hip pain and inability to bear weight. X-rays revealed Brodie's abscess in the proximal femur which was initially misdiagnosed as toxic synovitis with an incidental unicameral bone cyst (UBC).

Conclusion

Brodie's abscess can be a diagnosis that is easily missed and should be included in the differential diagnosis when a child presents with a limp, inability to bear weight, or when a cortical lucency is seen on X-ray. There are no other cases in the literature of Brodie's abscess presenting like toxic synovitis. This case is relevant to pediatricians and orthopedists, particularly pediatric orthopedists.

Post-traumatic Brodie's Abscess of the Tarsal Cuboid: A Case Report and Review of the Literature

Brodie's abscess of the tarsal cuboid is a relatively rare presentation of this disease. In this study, we present the case of a 20-year-old male with post-traumatic Brodie's abscess of the tarsal cuboid that was left untreated for three years after the traumatic episode (penetrating injury with a sharp piece of wood). The patient presented pain over the injured area, limping, while plain foot radiographs showed a small lytic cavitary area in the cuboid. The magnetic resonance imaging revealed the presence of the abscess in a 2-cm diameter cavity in the cuboid bone and chronic inflammation of the surrounding plantar musculature. The treatment regime included curettage of the cavity, debridement of the inflammatory tissues, and administration of antibiotics, according to the cultures harvested intraoperatively, for six weeks. During this period, symptoms completely resolved.

Coinfection of Streptococcus agalactiae and Tuberculous Osteomyelitis of Tibia Mimicking Brodie's Abscess in an Immunocompetent Adult: A Case Report

Introduction

Coinfection of tuberculous osteomyelitis with Streptococcus agalactiae has not been reported in an immunocompetent adult so far. The slow progress of tuberculous osteomyelitis, due to lack of significant elevations in the laboratory values and changes in the radiographic appearance, often leads to confusion with brodie's abscess. These two clinical conditions often lead to delay in diagnosis and progressive bone destruction. The aim of this report was to highlight recognizing the possibility of coinfections in tuberculous osteomyelitis and early treatment targeting both organisms simultaneously.

Case Report

We report a case of a 24-year-old male patient from Kerala, India presented with pain and swelling over distal leg for 2 weeks along with mild fever for 1 month. Imaging showed a brodie's abscess over distal tibia. Pus culture isolated S. Agalactiae. Bone biopsy reported as necrotizing granulomatous lesion. Computed tomography thorax was suggestive of necrotic tuberculous mediastinal and hilar lymphadenopathy. Based on histopathology, microbiology, and radiological findings, coinfection of tuberculous osteomyelitis and bacterial infection was confirmed and antitubercular therapy was started, along with antibiotics for S. agalactiae.

Conclusion

Tuberculous osteomyelitis mimicking brodie's abscess is very rare. It is important to consider coinfection in osteomyelitis and it is essential to do tuberculosis-polymerase chain reaction and histopathological examination, along with bacterial and fungal culture of pus in subacute osteomyelitis for the early diagnosis and treatment.

Cost-effectiveness of a bone substitute delivering gentamicin in the treatment of chronic osteomyelitis of long bones: Protocol for the CONVICTION randomized multicenter study

Introduction

Chronic osteomyelitis is a serious osteoarticular infection that most often occurs in the long bones, responsible for significant morbidity with the risk of fracture and amputation. Despite advances in both antibiotics and surgical treatment, the probability of recurrence of infection remains at around 20%. Cerament-G (BONESUPPORT AB, Sweden) is a synthetic bone substitute that fills the bone void left by surgery, prevents infection and promotes bone regeneration within this space. Cerament-G also provides the local delivery of high doses of gentamicin over several weeks. Two prospective observational studies described a number of infectious recurrences of 4 and 5% after the use of Cerament-G. Although available in France, Cerament-G is currently not reimbursed and its high cost constitutes a barrier to its use. We hypothesize that the use of Cerament-G will lead to fewer costs to the collectivity while improving patient utility and, as an innovative strategy, will be superior to standard of care on recurrence of infection.

Methods and analysis

The Conviction Study is a prospective, multicenter, randomized, single blind study conducted in 14 French Reference Centers for Complex Osteoarticular infections. The main objective is to evaluate the cost-effectiveness of using Cerament-G in the treatment of chronic long bone osteomyelitis by comparing this innovative strategy to standard of care. A cost-utility analysis from the collective perspective will be conducted over a 24-month time horizon after the initial surgery. The outcome for the main medico-economic evaluation will be Quality Adjusted Life Years (QALYs).

Discussion

The study is being conducted throughout the CRIOAc network in France, in referral centers for the management of complex infections which will facilitate patient recruitment. This study has several limitations: the investigators have to be trained to handle the device, and it was impossible to blind the surgeon.

Conclusion

If the use of Cerament-G is demonstrated to be superior to leaving the dead space empty during surgery for patients with stage III chronic long bone osteomyelitis, its use will be recommended to improve the prognosis of such patients, and this device may eventually qualify for reimbursement through the French Health Insurance scheme.

Ethics and dissemination

This protocol received authorization from the Ethics Committee CPP Sud Méditerranée V on April 27, 2021 (21.03.10.77652) and the French National Agency for Medicines and Health Products on May 6, 2021 (2020-A02299-30). Results will be disseminated to the scientific community through congresses and publication in peer-reviewed journals.

Imaging of bone marrow pitfalls with emphasis on MRI

Normal marrow contains both hematopoietic/red and fatty/yellow marrow with a predictable pattern of conversion and skeletal distribution on MRI. Many variations in normal bone marrow signal and appearances are apparent and the reporting radiologist must differentiate these from other non-neoplastic, benign or neoplastic processes. The advent of chemical shift imaging has helped in characterising and differentiating more focal heterogeneous areas of red marrow from marrow infiltration. This review aims to cover the MRI appearances of normal marrow, its evolution with age, marrow reconversion, variations of normal marrow signal, causes of oedema-like marrow signal, and some common non-neoplastic entities, which may mimic marrow neoplasms.

"The Terror of Death Began To Stalk Him": The Mysterious Fistula of Charles the Wise

For 23 years, Charles V "The Wise" of France suffered from a mysterious fistula on his left arm that continuously drained pus. For all this time, he believed that as soon as the fistula ceased to weep, he would have a mere 15 days before death followed. His death in 1380, at the young age of 42, seemingly proved this assumption correct. This paper explores the possible explanations from arsenic poisoning at the hands of his longtime nemesis Charles II, as many of his contemporaries believed, to an undiagnosed case of hidradenitis suppurativa, to an underlying tuberculosis infection, to the possibility that his condition was entirely self-inflicted. While it is impossible to determine a definitive cause, it is highly unlikely that Charles II "The Bad" of Navarre had anything to do with his rival's strange condition.

Tufted Angioma of the Index Finger Middle Phalanx

A tufted angioma is a benign vascular tumor of the skin and subcutaneous tissue that classically presents as a violaceous nodule on the trunk or extremities in early childhood. Tufted angiomas of the finger are uncommon, and intraosseous involvement of these tumors is exceedingly rare. When present in the bone, these lesions may be difficult to distinguish from the more common pediatric condition of osteomyelitis or osteoid osteoma. We present the clinical, radiographic, and histopathologic findings for a unique case of a tufted angioma with intraosseous involvement in the middle phalanx treated by surgical excision and curettage with preservation of function.

Educational Case: Osteoid Osteoma

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.¹

A Rare Presentation of Osteoid Osteoma in a 77-Year-Old Patient, Treated with Computer Tomography-Guided Percutaneous Radiofrequency Ablation

Osteoid osteoma (OO) is a benign bone forming tumor characterized by small size and a disproportionate amount of pain. They are most commonly seen between the ages of 5 and 30 years; however, they can be seen in the older patient albeit infrequently. The hands and feet are the least common site of OO among the extremity bones. We present a case of an OO in the hand of a 77-year-old man who underwent successful treatment with computed tomography–guided percutaneous radiofrequency ablation. We believe this is the oldest recorded patient in the medical literature with a histologically confirmed OO. The condition should therefore be considered in the differential diagnosis of a painful sclerotic bone lesion in this age group to avoid a delay in diagnosis and subsequent treatment.

Subacute osteomyelitis of the tibial diaphysis associated with Brodie's abscess: A rare case report of a four-year-old child

Introduction

Septic osteomyelitis is a hematogenous bacterial bone infection. The acute presentation is the most common; the subacute one is less frequent. The aim of our case report is to put forward the features of this uncommon presentation and to propose a therapeutic management.

Presentation of case

We report a rare case of subacute osteomyelitis associated with Brodie's abscess of the tibial diaphysis in a four-year-old child. The chief complaint was a pain in the left tibia evolving for five weeks. The radiological findings and the unusual location of this pathology suggested a malignant bone tumor. Thanks to imaging assessment and bone biopsy the diagnosis of subacute osteomyelitis associated with Brodie's abscess was made. Therefore, the child had antibiotic therapy and plaster immobilization to avoid pathological fracture. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal.

Discussion

We report an uncommon case of subacute osteomyelitis which evolved to Brodie's abscess with diaphyseal location. The mainstream treatment is surgery combined with antibiotics. However, medical treatment alone can lead to recovery without sequelae.

Conclusion

Because of the atypical location and presentation of subacute osteomyelitis, the other differential diagnoses, especially malignant bone tumors have to be eliminated. In some cases, treatment may be based on antibiotics therapy alone.

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The MRI findings can mimic a malignant bone tumor.

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The importance of the biopsy for the diagnosis.

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Antibiotic treatment without surgery is an alternative for the treatment of circumscribed Brodie’s abscess.

Brodie's Abscess: A Diagnostic Conundrum

Atraumatic limb pain in a child raises concerns in a medical setting. That is how a typical case of Brodie's abscess presents, having pain without any other symptoms of systemic illness. Assessment and investigations might also not reveal anything significant unless adequate imaging is done. Although Brodie's abscess has a very low rate of complications and morbidity/disability, it is important that such a presentation is assessed clinically with a diagnosis of Brodie's abscess in mind to ensure an uneventful and good outcome. We illustrate in this case report a similar presentation of an 11-year-old girl who had multiple visits to primary care. She was then assessed through radiological imaging. By the time of her diagnosis, her abscess had protruded through the skin. Thankfully management was done swiftly after identification and the final outcome was good with complete recovery.

Radiological changes in the formation of Brodie's abscess by sequential magnetic resonance imaging: a case report

Brodie's abscess is a relatively rare subacute form of osteomyelitis. Early diagnosis is challenging because of its insidious onset and vague symptoms. Magnetic resonance imaging is helpful in the diagnosis of Brodie's abscess; however, to date, no study has described the imaging findings of this disease in the early stage. Here, we present the case of a 14 year-old boy with Brodie's abscess in the proximal tibia. The lesion initially presented as a bone marrow edema in the proximal metaphysis of the left tibia on MRI and was misinterpreted as a bone bruise. Further radiological examination was performed 1 month later; this revealed the formation of an abscess cavity, which suggested Brodie's abscess. The patient was referred to our hospital and underwent curettage and debridement, which led to the definitive diagnosis of Brodie's abscess on histopathological findings and bacterial culture. On careful retrospective evaluation, the initial radiological findings suggested a microabscess on the metaphyseal side of the growth plate and bone marrow edema spreading from the lesion to the epiphysis. These radiological changes could be reliable evidence proving that the metaphyseal side of the growth plate is the origin of Brodie's abscess. Moreover, bone marrow edema with suspected microabscess in the metaphysis of the long bones can be the initial stage of the formation of Brodie's abscess and should be carefully followed up.

Rare Intercondylar Distal Femoral Brodie's Abscess in a 21-Year-Old Man Who Refused Medical Care for Three Years after Initial Symptoms

Brodie's abscess is a rare form of sub-acute osteomyelitis that implies the collection of pus inside bone tissue. The present paper presents an extremely rare case of Brodie's abscess located in the distal femur in a young male patient who refused medical care for three years and presented directly with spontaneous fistula and septic complications. Laboratory tests also suggested chronic septic alterations. Complex imaging investigations including X-ray (RX), computer tomography (CT) and Magnetic Resonance imaging (MRI) confirmed the diagnosis with characteristic aspects, such as the penumbra sign on the T1 weighted MRI image. Management included aggressive debridement, defect reconstruction, and long-term specific antibiotics according to culture harvested intra-operatively. Evolution was positive with inflammatory blood tests returning to physiological values within four weeks and patient full recovery within six months, without any physical deficits. The novelty aspect found in this case presentation is represented by the long-term natural evolution of this pathology, and the fact that even in these conditions, the Brodie's abscess did not evolve into a 'malignant' septic condition, but remained rather benign until the spontaneous fistula prompted the patient to seek medical care.

A Rare Presentation of Brodie Abscess in the Clavicle

A 12-year-old otherwise healthy boy presented with acute shoulder pain and remote history of trauma. Despite an unimpressive clinical examination, laboratory workup, and initial radiographic evaluation, the patient was ultimately diagnosed with a Brodie abscess of the distal clavicle. Complete resolution was achieved with débridement and tailored antibiotic therapy. These abscesses are rare, often presenting surreptitiously with nonspecific symptoms and without systemic signs of infection. Therefore, maintaining a broad differential and high clinical suspicion is crucial to mitigate the increased morbidity that can result from a delayed diagnosis.

[Differential diagnoses of inflammatory hip joint]

Die Differenzialdiagnosen der entzündlichen Hüfterkrankung spielen für die Diagnose des Hüftschmerzes eine bedeutende Rolle. Die rheumatologischen/entzündlichen Veränderungen des Hüftschmerzes mit dem entsprechenden Einsatz der Bildgebung wurden in Teil 1 des CME-Artikels abgehandelt. In diesem zweiten Teil wird ein systematischer Zugang erläutert, um die zahlreichen rheumatologischen Erkrankungen von Degenerationen, synovialen Tumoren und Infektionen zu unterscheiden. Die Interpretation der Pathologien in der Bildgebung im Zusammenhang mit dem klinischen Erscheinungsbild wird für die einzelnen Differenzialdiagnosen genauer erläutert. Das zeitgleiche Auftreten von unterschiedlichen Erkrankungen, zum Teil als sekundäre Komplikation, hat einen erheblichen Einfluss auf die Therapieplanung und sollte vom Radiologen erkannt werden.

Osseous Pathology on Wrist Magnetic Resonance Imaging

Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.

Multifocal subacute osteomyelitis in adjacent bones in the ankle without septic joint

Osteomyelitis is an inflammation involving bone and/or bone marrow most often the result of bacterial infection of the bone. In children, osteomyelitis most often has an acute presentation and is caused by hematogenous spread. When osteomyelitis is seen in the extremities, conventional radiography is the first-line imaging modality preformed for diagnosis with magnetic resonance imaging employed for further delineation or as a problem-solving tool. A healthy 6-year-old female presented with a history of nonspecific left leg pain for 3-5 weeks which gradually progressed to focal left ankle pain and swelling. Further workup revealed multifocal subacute osteomyelitis with Brodie's abscesses seen on imaging in the absence of a septic joint. This was an uncommon presentation for the following reasons: Patients with multifocal osteomyelitis usually present in the acute setting, as opposed to the subacute setting. When osteomyelitis is multifocal or Brodie's abscesses are present adjacent to the joint capsule, concomitant septic joint is commonly seen.

A Rare Case of Brodie's Abscess in HIV Patient Caused by Mycobacterium kansasii

We report a rare case of Brodie's abscess caused by Mycobacterium kansasii (M. kansasii). Our patient is a 39-year-old male who presented with right foot pain a month after a new diagnosis of HIV infection. X-ray and MRI were done, and the diagnosis of Brodie's abscess was confirmed. Surgical debridement was done, and bone cultures grew M. kansasii after five weeks. Brodie's abscess is a subacute form of osteomyelitis usually caused by Staphylococcus. Some other bacteria have been implicated in several case reports. To best of our knowledge, this is the first case of Brodie's abscess caused by M. kansasii. M. kansasii is the atypical mycobacteria causing infections in immunocompromised hosts as in HIV patients with low CD4 count. M. kansasii is usually associated with lung infections with rare extrapulmonary manifestations as in our case.

Treatment for Brodie's abscess of the radius in an adolescent: A case report

INTRODUCTION

Brodie's abscess is an uncommon type subacute osteomyelitis. It is typically localized in the metaphysis of tubular bones, particularly in the lower extremities. We herein report a rare case of the abscess appearing in the upper extremities. Furthermore, we successfully treated the large abscess without autogenous bone grafting.

PRESENTATION OF CASE

14-year-old female presented with pain and swelling on the right forearm. Plain radiograph and CT scan indicated a 10 cm longitudinal cortical bone hypertrophy and a well-defined radiolucent lesion in the diaphysis of the right radius. MRI demonstrated that the lesion was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging inside as well as outside the bone marrow of the radius. Laboratory data showed no inflammatory response, but Staphylococcus aureus was detected by biopsy. We diagnosed Brodie's abscess of the radius, and performed definitive surgery. Infected bone marrow was curetted and a bony sequestrum inside the cortical bone was harvested. We did not use autogenous bone grafting, since the upper extremities are areas of unloaded bone. Postoperative administration of antibiotics was subsequently performed. One year after surgery, the patient was asymptomatic and there were no complications or signs of infection recurrence.

CONCLUSION

We diagnosed and surgically treated a rare case of Brodie's abscess of the radius in an adolescent. An abscess with large cavity is usually treated by curettage and autogenous cancellous bone grafting. However, since the upper extremities are areas of unloaded bone, we successfully treated the abscess by debridement without bone grafting.

A Case of Brodie’s Abscess With Tibial Erosion and Extravasation Into Surrounding Soft Tissue

Atraumatic limb pain and limp is a common pediatric presentation in the emergency department in the United States. In a majority of cases, these presentations are benign. However, in cases where pediatric patients are repeatedly presenting for atraumatic limb pain, further investigation is required. We present such the case of a 14-year-old female with acute worsening of progressive atraumatic knee pain who was found to have a Brodie’s abscess, a subacute pyogenic form of osteomyelitis. This is a particularly challenging diagnosis, as it often presents with no associated symptoms such as fever or weight loss. The consequences of missing this diagnosis include permanent disability and potential amputation, but excellent outcomes can be expected for those who undergo timely surgical debridement and irrigation. We discuss the etiology, common presentations, and treatment of this rare but potentially limb-threatening disease in the hope that clinicians will consider this diagnosis in cases of persistent or progressive atraumatic limb pain.

Brodie's abscess of the calcaneus in an adult patient

Brodie's abscess of the calcaneus is an uncommon benign lesion that has rarely been reported in the literature. This study presents a rare case of a Brodie's abscess of the calcaneus caused by Staphylococcus aureus in an adult patient. A 46-year-old immunocompetent man had undergone nonsurgical treatment since childhood owing to the diagnosis of a heel spur. Radiological evaluation revealed a benign radiolucent cystic lesion of the calcaneus surrounded by a sclerotic rim. This condition was accompanied by perilesional bone marrow edema. Thereafter, surgical treatment was planned. During surgery, the content of the lesion was observed to be purulent. Meticulous intralesional debridement was performed, and antibiotic-loaded bone cement beads were placed. Subsequent to microbiological and pathological examinations, the cystic lesion was confirmed to be a Brodie abscess; however, direct clinical evidence of an intraosseous infection was lacking. The patient was followed up for 14 months with no complications until recovery. A Brodie abscess may mimic bone tumors. The onset of a Brodie abscess is insidious, and the clinical findings of such lesions may be obscure. A Brodie abscess of the calcaneus should be considered in the differential diagnosis of patients with chronic heel pain when suspicious radiological findings are evident.

Brodie's abscess of the calcaneus in an adult patient

Brodie's abscess of the calcaneus is an uncommon benign lesion that has rarely been reported in the literature. This study presents a rare case of a Brodie's abscess of the calcaneus caused by Staphylococcus aureus in an adult patient. A 46-year-old immunocompetent man had undergone nonsurgical treatment since childhood owing to the diagnosis of a heel spur. Radiological evaluation revealed a benign radiolucent cystic lesion of the calcaneus surrounded by a sclerotic rim. This condition was accompanied by perilesional bone marrow edema. Thereafter, surgical treatment was planned. During surgery, the content of the lesion was observed to be purulent. Meticulous intralesional debridement was performed, and antibiotic-loaded bone cement beads were placed. Subsequent to microbiological and pathological examinations, the cystic lesion was confirmed to be a Brodie abscess; however, direct clinical evidence of an intraosseous infection was lacking. The patient was followed up for 14 months with no complications until recovery. A Brodie abscess may mimic bone tumors. The onset of a Brodie abscess is insidious, and the clinical findings of such lesions may be obscure. A Brodie abscess of the calcaneus should be considered in the differential diagnosis of patients with chronic heel pain when suspicious radiological findings are evident.