Improvement of chronic osteomyelitis after granulocyte colony stimulating factor

Abstract

Background: chronic osteomyelitis represents a persistent bone and bone marrow infection easy to diagnose in the presence of pain, erythema, swelling, and a draining sinus but more difficult to detect in the absence of the preceding features and with a painful orthopaedic prosthesis.

Case description: we report upon an elderly gentleman with myelodysplasia requiring revision surgery for a fractured prosthetic left knee. He had clinical, laboratory, and radiological features of chronic osteomyelitis that improved only with administration of granulocyte colony stimulating factor (G-CSF).

Literature review: G-CSF has been successfully employed to treat resistant osteomyelitis in three young patients with primary defects of monocyte and neutrophil killing. A randomized trial confirmed the efficacy of G-CSF in the treatment of chronic osteomyelitis in twenty patients with diabetic foot ulcers and a rat model confirmed the efficacy of G-CSF in acute osteomyelitis.

Clinical relevance: our case highlights the usefulness of G-CSF treatment for immune suppressed patients with resistant chronic osteomyelitis.

Fig. 1

MRI scan of left knee and femoral shaft from February 2010. Axial T1 weighted images: a with gadolinium enhancement, b without gadolinium enhancement. There is enhancing tissue of the central marrow material on the left.Bottom (c): axial T2 weighted images showing high signal in the marrow and surrounding soft tissues

Fig. 2

Time course of the patient’s illness showing the behaviour of C-reactive protein (continuous line; mg/l) and alkaline phosphatase (dashed line; U/l) in response to rotating antibiotics and to G-CSF

Fig. 3

MRI scan of the left knee and femoral shaft from August 2010. Coronal T1 weighted images a with gadolinium enhancement, b without gadolinium enhancement. There is no enhancing tissue and no evidence of inflammation