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Case Reports
. 2014 Apr 24;49(4):401-4.
doi: 10.1016/j.rboe.2014.04.010. eCollection 2014 Jul-Aug.

Garré's sclerosing osteomyelitis: case report

Frederico Barra de Moraes  1 , Tainá Melo Vieira Motta  1 , Alessandra Assis Severin  1 , Deniel de Alencar Faria  1 , Fernanda de Oliveira César  1 , Siderlei de Souza Carneiro  2
Affiliations
Case Reports

Garré's sclerosing osteomyelitis: case report

Frederico Barra de Moraes et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

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.

Relatar um caso raro de osteomielite esclerosante de Garrè. Paciente feminino, 54 anos, com história de tratamento de lúpus com corticoide havia 20 anos e osteoporose, em uso de alendronato havia cinco anos. Apresentava edema e limitação do joelho esquerdo havia um ano, derrame leve, dor à palpação metafisária, afebril, bom estado geral, sem secreção local. Imagens do joelho evidenciaram osteólise trabecular da metáfise distal do fêmur e reação periosteal nas duas tíbias proximais e nos dois fêmures distais, compatíveis com osteomielite crônica, de baixa virulência e progressão lenta. Hipersinal em T2 no fêmur e tíbia à ressonância. Curetagem do fêmur distal esquerdo, com saída de secreção, mas cultura negativa. Biópsia evidenciou infecção e inflamação crônica, fibrose, reação xantogranulomatosa e focos de supuração. Feita antibioticoterapia por seis meses. Etiologia não esclarecida, suspeita de infecção bacteriana, mas geralmente a cultura é negativa, processo crônico mantido por infecção de baixa virulência ou mesmo após o tratamento. Diagnósticos diferenciais: displasia fibrosa, sífilis, pustulose palmoplantar, retocolite, Crohn, Sapho (sinovite, acne, pustulose, hiperostose, osteíte) e Paget. Unifocais: osteoma osteoide, Ewing, osteossarcoma e granuloma eosinofílico.

Keywords: Osteomyelitis/diagnosis; Osteomyelitis/surgery; Osteomyelitis/therapy.

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Figures

Fig. 1
Fig. 1
Radiographic appearance of the lesion. (A) Radiograph in anteroposterior view showing periosteal reaction in the femur. (B) Radiograph in lateral view showing periosteal reaction in the tibia. (C) Radiograph in lateral view showing distal femur after the operation, with a bone window for drainage, curettage, culturing and biopsy, and showing the various layers of the periosteal reaction.
Fig. 2
Fig. 2
Computed tomography of the left knee, with bone window, showing trabecular osteolysis and periosteal reaction. Coronal (A), sagittal (B) and axial slice (C).
Fig. 3
Fig. 3
Magnetic resonance of the left knee. Coronal (A) and axial (B) T2 slices showing hypersignal indicative of purulent secretion.
Fig. 4
Fig. 4
Histological study on bone biopsy from the left femur, in hematoxylin-eosin (A) and (B), showing infection and chronic inflammation marked by fibrosis, xanthogranulomatous reaction and foci of suppuration indicative of GSO.
See this image and copyright information in PMC

References

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