Intralesional Methylprednisolone for Painful Solitary Eosinophilic Granuloma of the Appendicular Skeleton in Children

Abstract

Biopsy and direct intralesional methylprednisolone injection is safe for symptomatic eosinophilic granulomas of the appendicular skeleton in children with effective clinical and imaging resolution of the lesions.

Current concepts for the diagnosis and management of eosinophilic granuloma of bone

“…CT-guided biopsy for eosinophilic granuloma has been effective for histological diagnosis, with low morbidity and a diagnostic accuracy of 70–100 % [5, 31–38]. Although anecdotally excellent results with biopsy alone have been previously reported for patients with eosinophilic granulomas [39], biopsy should not be considered as a strategy for treatment of these patients but rather as a step to confirm diagnosis [26, 32, 33, 36–38, 40–42]. …”

“…Moreover, although solitary eosinophilic granuloma is considered a benign lesion, without treatment, the time required for resolution is unpredictable and can be associated with significant morbidity secondary to unremitting pain, restricted activity, growth disturbance, or pathological fracture [26, 47]. Therefore, we recommend that these patients should undergo biopsy for histological diagnosis, and treatment is then considered [36–38]. …”

“…1, 2, 3) or the extremities (Fig. 4) may be treated with intralesional methylprednisolone injection after tissue biopsy for histological diagnosis [8, 26, 31–33, 36–38].

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“…The amount of methylprednisolone acetate injected was established empirically on the basis of the size of the lesion. A minimum of 40 mg for small lesions involving less than half the diameter of the involved bone, and up to 160 mg for large lesions of the pelvis has been recommended [36–38]. …”

“…However, in patients with symptomatic lesions, treatment is required. In view of the usually benign clinical course of the disease, in these patients a simple, minimally invasive, outpatient treatment with a low rate of complications such as CT-guided intralesional methylprednisolone injection may be considered the treatment of choice [36–38]. …”