Brodie abscess of the jaw: An unusual presentation of a rare complication of subacute osteomyelitis

Abstract

Background: A Brodie abscess is a rare subtype of subacute osteomyelitis which can be acquired from local trauma or hematogenous spread secondary to transient bacteremia. However, to date there have been no reports of the presence of a Brodie abscess in the mandible. Case representation: Here we report a case of a 51-year-old female who presented to the emergency department with a 4-day history of left sided facial pain and trismus after recent dental manipulation. A computed tomography (CT) scan showed the presence of osteomyelitis with a Brodie abscess in the mandibular condyle. Empiric treatment was initiated with ampicillinsulbactam. After seven days of treatment, the antibiotics were switched to ceftriaxone and metronidazole on discharge. Five days later the patient returned to the hospital with the same symptoms that she initially presented with, indicating a failure of treatment. Follow-up CT scan showed the persistence of the Brodie abscess. Subsequently, IV ertapenem was initiated for a duration of eight weeks and the patient was instructed to obtain an oral surgery evaluation as an outpatient. Conclusions: This case highlights a unique presentation of a Brodie abscess, which has been previously exclusively found in long bones, and raises awareness of such a complication in patients whose facial erythema, pain, and swelling may not improve with first line therapy for a simple dental infection. Additionally, we highlight that the unique location of the mandibular condyle poses a treatment challenge and surgical replacement of the jaw appears to be the lone curative modality.