Garré’s sclerosing osteomyelitis: case report

Abstract

The aim of this study was to report on a rare case of Garré’s sclerosing osteomyelitis. The patient was a 54-year-old woman with a history of treatment for lupus using corticoids for 20 years, and for osteoporosis using alendronate for five years. She presented edema and developed a limitation of left knee movement one year earlier, with mild effusion and pain on metaphyseal palpation, but without fever. She was in a good general state, without local secretion. Images of her knee showed trabecular osteolysis of the distal metaphysis of the femur and a periosteal reaction in both proximal tibias and both distal femurs, compatible with chronic osteomyelitis of low virulence and slow progression. Magnetic resonance imaging showed T2 hypersignal in the femur and tibia. Curettage was performed on the left distal femur, with release of secretion, but this was negative on culturing. A biopsy showed chronic infection and inflammation, fibrosis, xanthogranulomatous reaction and foci of suppuration. Antibiotic therapy was administered for six months. The etiology was not clarified: bacterial infection was suspected, but culturing was generally negative. The chronic process was maintained by low-virulence infection or even after treatment. The differential diagnoses were fibrous dysplasia, syphilis, pustulosis palmoplantaris, rectocolitis, Crohn's disease, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) and Paget's disease. The unifocal diseases were osteoid osteoma, Ewing's disease, osteosarcoma and eosinophilic granuloma.

Pathomorphological Features of Bone Lesions and Correlation of Clinical, Laboratory and Morphometric Criteria in Patients With Latent Sclerosing Hematogenous Osteomyelitis (Garré)

“…Такая форма сго, по нашему мнению, предполагает использование более агрессивных методов лечения -как хирургического, так и консервативного. что касается методов лечения сго, то большинство авторов склоняются к необходимости сочетать консервативное и хирургическое лечение [1,3,12,14]. определенные трудности создает выбор метода резекции пораженных тканей кости: внутриочаговой, краевой или блок-резекции.…”

“…Разумеется, резекция кости бóльшего или мéньшего объема должна дополняться длительным (до 1,5-2 мес. и дольше) применением антибиотикотерапии остеотропными препаратами в субмаксимальных дозах [1,10,12].…”

“…[7]. опыт сотен собственных патоморфологических исследований тканей очагов го убеждает, что остео миелит с латентным течением, с точки зрения как клиники, так и патоморфологии, не является однородным понятием, поскольку сходная клиническая картина может наблюдаться при поражениях принципиально различных форм, например, абсцесса Броди как типичной деструктивной формы очага, а также склерозирующего гематогенного остеомиелита (сго), известного в литературе как остеомиелит гарре [8][9][10][11][12].…”

A 53-year-old man with a sclerosing rib lesion

“…Chronic sclerosing osteomyelitis was first described by Garré in 1893 as a special form of osteomyelitis with characteristic thickening of and distended local bone. [ 18 , 22 ] Patients with sclerosing osteomyelitis of Garré usually present with chronic pain and progressive swelling over a long period. However, this condition is usually not accompanied by suppuration or osteonecrosis.…”

A possible case of Garre’s sclerosing osteomyelitis from Medieval Tuscany (11th–12th centuries)

“…This appears to represent an acute osteomyelitis that persisted in a chronic state. Chronic sclerosing osteomyelitis of Garre is a rare form of chronic osteomyelitis first described by Carl Alois Philipp Garre in 1893; other names are chronic osteomyelitis with proliferative periostitis, chronic sclerosing osteomyelitis, ossifying periostitis or non-suppurative chronic sclerosing osteomyelitis (Moraes et al, 2014). This condition affects young children and adults, predilecting the male sex (Vannet et al, 2014).…”