Chronic Osteomyelitis Secondary to Hydatid Disease of Bone - A Case Report

Abstract

Introduction: Osseous hydatidosis is a rare orthopedic condition. Osseous hydatidosis leading to chronic osteomyelitis is rarer with very few articles published on it. This presents a challenge in diagnosis and treatment. Here, we report a patient with chronic osteomyelitis secondary to Echinococcal infection.

Case report: A 30-year-old lady with fracture left femur operated elsewhere presented with a draining sinus. She underwent a debridement and sequestrectomy. The condition was quiescent until 4 years later when symptoms recurred. She again underwent debridement, sequestrectomy, and saucerisation. The biopsy showed hydatid cyst.

Conclusion: The diagnosis and treatment are challenging. The chances of recurrence are very high. Multimodality approach is recommended.

Keywords: Osseous hydatidosis; chronic osteomyelitis; hydatid cyst.

Figure 1

Abscess showing impending rupture.

Figure 2

(a-c) Pre-operative AP and lateral view of the left distal femur with a sinusogram.

Figure 3

MRI revealed well defined lobulated intraosseous high signal area with peripheral T2 hypointense rim in proximal femur that extends 17 cm from the joint surface.

Figure 4

Intraoperative gross pathology specimen (Scale: one square on the green towel is 4 mm ×4 mm).

Figure 5

(Hematoxylin and Eosin): Fragments of acellular lamellated membranes of hydatid ectocyst (arrow). Fragments of fibrocollagenous tissue with dense chronic inflammation and cancellous bone are also seen. Foreign body giant cell reaction is seen as marked with arrow heads. (a) (×50 magnification), (b) (×100 magnification), (c) (×100 magnification), (d) (×200 magnification).