Primary subacute epiphyseal and metaepiphyseal osteomyelitis in children

Abstract

We present three children with primary subacute epiphyseal and metaepiphyseal osteomyelitis. The diagnosis was delayed because of subtle radiological findings and mild general symptoms. Primary epiphyseal osteomyelitis is extremely rare. We believe that this is the first time that the MRI findings have been presented. In the first case they revealed a perforation into the knee and therefore an intra-articular epiphyseal approach was used for debridement. In the second and third cases the metaepiphyseal lesions showed considerable physical involvement and a metaphyseal approach was chosen. We believe that in this condition MRI is essential both for diagnosis and in the planning of surgical treatment.

Surgical Debridement Provided for Fast Recovery in Metaepiphyseal Haematogenous Osteomyelitis with Adjacent Subperiostal Abscess Formation in Two Children

“…But even in the absence of positive culture patients with epiphyseal OM are reported to improve during the course of antibiotic treatment [19]. Therefore, antibiotic regimen has to be started at the onset of symptoms targeting Staphylococcus aureus, which accounts for approximately 50% to 60% of AHMO [7,19,21].…”

Subacute metacarpal osteomyelitis in a child

“…Several studies showed that subacute osteomyelitis occurred when there was a decreased bacterial virulence and an increased host resistance (5-7). Moreover, early antibiotic therapy in the acute form seems to as a rule result in the occurrence of subacute form since it decreases the virulence of infectious agents (4,5). Subacute metacarpal osteomyelitis may occur in metaphysis but also in both diaphysis and epiphysis, and can be described in radiological fi ndings according to Roberts' classifi cation (7).…”

“…In spite of the benign nature of this aff ection, other benign and malignant disorders must be considered on diff erential diagnosis, including eosinophilic granuloma, osteoid osteoma, chondroblastoma, tuberculosis, fungal infection, osteosarcoma, Ewing's sarcoma, leukemia and round cell tumors (9-11). Actually, studies of subacute osteomylitis have demonstrated the value of magnetic resonance imaging (MRI) in diagnosing osteomyelitis in children, also pointing to gadolinium-enhanced imaging as the most sensitive one (4,12,13). MRI exploration helps localize the aff ection of the bone and provide an objective view of the lesion extent (10,14).…”

Musculoskeletal Infection

“…There is also an uncommon subacute primary form that occurs in early childhood; this follows direct hematogenous seeding of the epiphysis [ 30 ]. Pain and limp are often recurrent.…”

“…19.17 ), usually without any other bone involvement, and nuclear scintigraphy is positive. MRI demonstrates typical fi ndings of osteomyelitis [ 30 ]. Differential diagnoses are limited and include chondroblastoma, …”