Brodie's Abscess: A Systematic Review of Reported Cases

Abstract

Introduction: Brodie's abscess is a form of osteomyelitis. Since its first appearance in the medical literature in 1832, numerous cases have been described. The aim of this article is to provide the first comprehensive overview of published cases of Brodie's abscess, and to describe diagnostic methods, therapeutic consequences and outcomes.Methods: According to PRISMA guidelines a systematic review of the literature was performed. All published data in English or Dutch were considered for inclusion with no limitations on publication date. Data was extracted on demography, duration of symptoms, signs of inflammation, diagnostic imaging, causative agent, treatment and follow-up.Results: A total of 70 articles were included, reporting on a total of 407 patients, mostly young (median age 17) males (male:female ratio 2.1:1). The median duration of symptoms before diagnosis was 12 weeks (SD 26). Mostly consisting of pain (98%) and/or swelling (53%). 84% of all patients were afebrile, and less than 50% had elevated serum inflammation markers. Diagnosis was made with a combination of imaging modalities: plain X-ray in 96%, MRI (16%) and CT-scan (8%). Treatment consisted of surgery in 94% of the cases, in conjunction with long term antibiotics in 77%. Staphylococcus aureus was the pathogen most often found in the culture (67,3%). Outcome was generally reported as favorable. Recurrence was reported in 15,6% of the cases requiring further intervention. Two cases developed permanent disability.Conclusion: Brodie's abscess has an insidious onset as systemic inflammatory signs and symptoms were often not found. Treatment consisted mostly of surgery followed by antibiotics (77%) or only surgery (17%) and outcomes were generally reported as favourable.

Brodie’s abscess associated with soft tissue swelling in an athlete in Abidjan (Ivory Coast)

“…Management must be multidisciplinary, involving the surgeon, radiologist, infectiologist and pathologist [2]. The treatment, as was the case in our patient, is surgical (drainage of pus and bone excision) combined with antibiotic therapy [1]. Staphylococcus aureus was isolated from our patient.…”

“…Staphylococcus aureus was isolated from our patient. This germ is most often found in the literature [1]. The low number of African publications on the subject should not lead us to underestimate the prevalence of this form of osteomyelitis [7] among the large number of chronic osteomyelitis in sub-Saharan Africa [8].…”

“…Publications concerning Brodie's abscess come mainly from developed countries. There are very few publications from Africa [1]. We report a rare case of the association of a Brodie's abscess with a swelling of the soft tissues in a sportsman in Abidjan (Ivory Coast).…”

“…Brodie's abscess is a subacute form of osteomyelitis, presenting as a collection of pus on the bone [1]. The onset is often insidious with clinical signs and deceptive imaging that may mimic a bone tumor [2].…”

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

“…The disorder affects 0.185 per 100,000 children yearly and is twice as common in males [2]. The average age at presentation is 17 years [3]. This diagnosis may be missed multiple times by emergency medicine and primary care physicians, as there are relatively few clinical indicators other than slowly progressive limb pain.…”