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

Abstract

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: A Diagnostic Conundrum

“…Brodie's abscess has an insidious onset and can be difficult to diagnose [5]. X-rays taken at the first presentation should be of good quality and ideally should cover sufficient length of the bone above and below the joint or the area of concern in order to have a proper assessment of the metaphysis, physis, and epiphysis [2].…”

“…Patients usually remain afebrile often with unremarkable inflammatory markers and rarely exhibiting any other signs of systemic illness [3]. Therefore, in the absence of any physiological or hematological signs of illness other than pain, many of these cases can end up being symptomatically treated until definitive testing and management take place [4,5]. Here, we present a similar case with all the hallmark features of Brodie's abscess.…”

Brodie abscess in an 87-year-old man

“…2,3 These pathogens are also the most common cause of acute infections, including osteomyelitis. 6 However, patients with Brodie abscess can present with an insidious course, with or without fever, [7][8][9] potentially leading to misdiagnosis of a benign or malignant bone tumor and delay in appropriate antibiotic treatment. The main source of infection is by hematogenous spread, which is often unclear because of the long clinical course of the disease.…”

“…However, the treatment should be initiated as soon as possible when a chronic abscess is suspected, as case reports also reveal that delay of treatment can slowly exacerbate the abscess, eventually leading to a sinus tract, a fi stula connecting skin and soft tissue, or bone fracture. 3,9,11 Brodie abscess is rare in older adults. However, timely diagnosis and treatment can prevent exacerbation of the abscess and avoid the need for additional surgical treatment such as bone grafting or amputation, thus shortening the duration of hospitalization and preventing long-term complications.…”

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

“…Brodie's abscess is a rare form of chronic pyogenic sub-acute osteomyelitis of the bones, with an insidious onset usually and without obvious clinical symptomatology, which was first described by Sir Benjamin Brodie in 1832 [1][2][3][4][5][6][7][8][9][10]. Most of the cases involve the metaphysis, epiphysis, or diaphysis of the long bones of the lower limb such as the femur or the tibia [1,2,4,7].…”