A Case Report of Brodie's Abscess of the Cuboid Treated by Anatomic Antibiotic-Cement Spacer.

Background: A case of chronic osteomyelitis with Brodie's abscess of the cuboid caused by a wooden foreign body penetrating the plantar foot. Total cuboidectomy was carried out with implantation of an anatomically molded antibiotic-impregnated cement spacer with culture-specific postoperative intravenous antibiotics. At six months of follow-up, the patient was completely asymptomatic without evidence of a recurrence of infection. Final radiographs also didn't show spacer migration or surrounding bone erosions. The spacer obviated the need for any foot fusion which preserved foot biomechanics. The patient didn't need to use any braces or insoles. Conclusion: Osteomyelitis should always be on the differential list of lytic lesions of the tarsal bones, especially if there is a history of prior foot trauma. In this case, cuboid excision and placement of an antibiotic-impregnated cement spacer provided sustained relief of symptoms without evidence of recurrence or complications for six months.Level of Evidence: V.

An unusual case of Brodie's abscess in the humerus of an adult female.

Brodie's abscess is a manifestation of subacute to chronic osteomyelitis, characterized as intraosseous abscess formation, usually on the metaphysis of the long tubular bones in the lower extremities of male pediatric patients. Clinically, Brodie's abscess presents with atraumatic bone pain of an insidious onset, with absence of systemic findings. Delay in diagnosis is common, as diagnostic imaging, followed by biopsy for culture and histologic examination are generally required to secure a diagnosis of Brodie's abscess. Treatment of Brodie's abscess is non-standardized, and usually consists of surgical debridement and antibacterial therapy. Despite the variability in therapeutic approaches, outcomes of Brodie's abscess treated with surgery and antibiotics are favourable. Herein we report a case of a delayed diagnosis of Brodie's abscess in the upper extremity of an adult female. While she improved with treatment of Brodie's abscess, the case serves to remind clinicians to consider this entity in adult individuals who present with atraumatic bone pain.

Brodie's abscess as a late complication of external fixation of the distal radius: A case report.

CASE: A 41-year-old male presented with an insidious onset of pain and swelling about the dorsal wrist, and was found to have a Brodie's abscess in the distal radius. The patient had a history of a distal radius fracture, treated with external fixation, nineteen years prior, which we believe contributed to the infection. The patient was treated surgically with abscess irrigation, debridement, bony curettage, bioactive glass S53P4 allograft, with concurrent antibiotic therapy. CONCLUSION: Brodie's abscesses can have atypical presentations, and a thorough history must be obtained from patients to identify any potential sources of infection.

Pediatric Hip Pain with Bone Lesion, Sepsis, and Occam's Razor = Brodie's Abscess Case Report.

Introduction: Brodie's abscess is one type of subacute osteomyelitis that can be difficult to diagnose because characteristic signs and symptoms can be subtle and non-specific. Up to 90% of Brodie's abscess cases are initially misdiagnosed, with a mean delay of 3 months to the correct diagnosis, with 50% of them misdiagnosed as tumors. Other conditions can also present quite similarly. Case Report: A 7-year-old male presented with complaints of hip pain and inability to bear weight. X-rays revealed Brodie's abscess in the proximal femur which was initially misdiagnosed as toxic synovitis with an incidental unicameral bone cyst (UBC). Conclusion: Brodie's abscess can be a diagnosis that is easily missed and should be included in the differential diagnosis when a child presents with a limp, inability to bear weight, or when a cortical lucency is seen on X-ray. There are no other cases in the literature of Brodie's abscess presenting like toxic synovitis. This case is relevant to pediatricians and orthopedists, particularly pediatric orthopedists.

A Rare Case of Brodie's Abscess in the Tibial Diaphysis Masquerading as a Vaso-occlusive Sickle Crisis.

We present the case of a 19-year-old male with a history of sickle cell anemia who presented to the hospital with worsening lower extremity pain. Given his acute presentation and history of recurrent pain crises, he was admitted to the hospital for management of a suspected acute pain crisis. However, due to continued pain, imaging was obtained which revealed a different diagnosis for the cause of his symptoms. MRI of the left lower leg revealed heterogenous T1 and T2 hyperintense signals within the proximal tibial diaphysis measuring 6.6 × 1.6 × 2.2 cm with a thick rim of peripheral irregular enhancement with surrounding periosteal reaction and soft tissue edema, concerning for osteomyelitis and developing Brodie's abscess. The patient underwent tibia irrigation and debridement with the placement of vancomycin and tobramycin beads. Perioperatively, no purulence was noted within the soft tissues, and no organisms were grown on tissue cultures. The patient's pain improved and he was discharged home with a plan to complete six weeks of intravenous antibiotics. This case represents the need to differentiate Brodie's abscess from a sickle cell crisis. Clinicians should also be aware that patients with sick cell disease are prone to Brodie's abscess and it should be a differential for symptoms of relenting bone pain.

Post-traumatic Brodie's Abscess of the Tarsal Cuboid: A Case Report and Review of the Literature.

Brodie's abscess of the tarsal cuboid is a relatively rare presentation of this disease. In this study, we present the case of a 20-year-old male with post-traumatic Brodie's abscess of the tarsal cuboid that was left untreated for three years after the traumatic episode (penetrating injury with a sharp piece of wood). The patient presented pain over the injured area, limping, while plain foot radiographs showed a small lytic cavitary area in the cuboid. The magnetic resonance imaging revealed the presence of the abscess in a 2-cm diameter cavity in the cuboid bone and chronic inflammation of the surrounding plantar musculature. The treatment regime included curettage of the cavity, debridement of the inflammatory tissues, and administration of antibiotics, according to the cultures harvested intraoperatively, for six weeks. During this period, symptoms completely resolved.

Absceso de Brodie en la clavícula: una forma poco frecuente de presentación / Brodie abscess in the clavicle: an uncommon presentation

La osteomielitis (OM) se define como la inflamación ósea de origen infeccioso. La forma aguda es frecuente en la edad pediátrica. El absceso de Brodie es un tipo de osteomielitis subaguda, históricamente con baja incidencia, pero que actualmente se presenta un aumento de la misma. De poca repercusión clínica, con pruebas de laboratorio inespecíficas y estudios radiológicos de difícil interpretación, es crucial la sospecha diagnóstica. Se asemeja a procesos neoplásicos, benignos o malignos. Recae en la experiencia del profesional realizar el diagnóstico adecuado. El tratamiento consiste en antibioticoterapia, tanto parenteral como por vía oral, y eventualmente drenaje quirúrgico. Presentamos una paciente sana que consultó por una tumoración en topografía de clavícula izquierda de 3 meses de evolución. Se realizó diagnóstico de absceso de Brodie, inició tratamiento y se obtuvo una buena respuesta. Resulta imprescindible tener un alto índice de sospecha de esta entidad para no someter al paciente a estudios, pruebas invasivas o tratamientos erróneos, y evitar secuelas a futuro.

Osteomyelitis is defined as an inflammation of the bone caused by infection. Acute osteomyelitis is common in pediatrics. A Brodie abscess is a type of subacute osteomyelitis, with a historically low incidence; however, its incidence is currently increasing. Given its little clinical impact, with non-specific laboratory tests and radiological studies of difficult interpretation, diagnostic suspicion is crucial. It resembles neoplasms, either benign or malignant. An adequate diagnosis falls on the health care provider's experience. Treatment consists of antibiotics, both parenteral and oral, with potential surgical drainage. Here we describe the case of a healthy female patient with a tumor found in the topography of the left clavicle 3 months before. She was diagnosed with Brodie abscess; treatment was started with a good response. A high index of suspicion of Brodie abscess is critical to avoid invasive tests and studies or inadequate treatments, and to prevent future sequelae.

Tuberculosis Osteomyelitis as an Indolent Bone Mass.

Tuberculosis (TB) is a pulmonary disease with potential extrapulmonary manifestations that is caused by the bacteria Mycobacterium tuberculosis. Despite advancements in treatment, TB remains a worldwide public health concern. TB osteomyelitis accounts for approximately 3-5% of all extrapulmonary TB cases. We present a case of humeral TB osteomyelitis in a 22-month-old female with no pulmonary or systemic symptoms. This case offers insight into the diagnosis and management of TB osteomyelitis. A 22-month-old previously healthy Haitian-American female presented with a one-month history of a palpable mass over the anterolateral aspect of the proximal humerus without overlying erythema or soft tissue swelling. No additional symptoms were reported. She had no recent sick contacts but had visited Haiti during her infancy. Right proximal humerus X-ray and subsequent MRI revealed proximal humeral osteomyelitis with an intraosseous Brodie's abscess. Incision and drainage extracted caseous material, which tested positive for Mycobacterium tuberculosis via a polymerase chain reaction. The diagnosis was confirmed via positive QuantiFERON-TB Gold and purified protein derivative testing. The patient was treated with levofloxacin, isoniazid, pyrazinamide, pyridoxine, and rifampin during the hospitalization. Following discharge, she was continued on her antibiotic regimen and managed by the Florida Department of Health. Post-discharge, X-rays at three and twelve months showed evidence of lesion healing. TB osteomyelitis is a rare manifestation of TB infection, which may present insidiously without systemic or pulmonary symptoms. As timely treatment is vital to preventing complications, bone masses of unknown etiology should be investigated for TB infection, even without additional symptoms.

Coinfection of Streptococcus agalactiae and Tuberculous Osteomyelitis of Tibia Mimicking Brodie's Abscess in an Immunocompetent Adult: A Case Report.

Introduction: Coinfection of tuberculous osteomyelitis with Streptococcus agalactiae has not been reported in an immunocompetent adult so far. The slow progress of tuberculous osteomyelitis, due to lack of significant elevations in the laboratory values and changes in the radiographic appearance, often leads to confusion with brodie's abscess. These two clinical conditions often lead to delay in diagnosis and progressive bone destruction. The aim of this report was to highlight recognizing the possibility of coinfections in tuberculous osteomyelitis and early treatment targeting both organisms simultaneously. Case Report: We report a case of a 24-year-old male patient from Kerala, India presented with pain and swelling over distal leg for 2 weeks along with mild fever for 1 month. Imaging showed a brodie's abscess over distal tibia. Pus culture isolated S. Agalactiae. Bone biopsy reported as necrotizing granulomatous lesion. Computed tomography thorax was suggestive of necrotic tuberculous mediastinal and hilar lymphadenopathy. Based on histopathology, microbiology, and radiological findings, coinfection of tuberculous osteomyelitis and bacterial infection was confirmed and antitubercular therapy was started, along with antibiotics for S. agalactiae. Conclusion: Tuberculous osteomyelitis mimicking brodie's abscess is very rare. It is important to consider coinfection in osteomyelitis and it is essential to do tuberculosis-polymerase chain reaction and histopathological examination, along with bacterial and fungal culture of pus in subacute osteomyelitis for the early diagnosis and treatment.

Brodie abscess in the clavicle: an uncommon presentation. / Absceso de Brodie en la clavícula: una forma poco frecuente de presentación.

Osteomyelitis is defined as an inflammation of the bone caused by infection. Acute osteomyelitis is common in pediatrics. A Brodie abscess is a type of subacute osteomyelitis, with a historically low incidence; however, its incidence is currently increasing. Given its little clinical impact, with non-specific laboratory tests and radiological studies of difficult interpretation, diagnostic suspicion is crucial. It resembles neoplasms, either benign or malignant. An adequate diagnosis falls on the health care provider's experience. Treatment consists of antibiotics, both parenteral and oral, with potential surgical drainage. Here we describe the case of a healthy female patient with a tumor found in the topography of the left clavicle 3 months before. She was diagnosed with Brodie abscess; treatment was started with a good response. A high index of suspicion of Brodie abscess is critical to avoid invasive tests and studies or inadequate treatments, and to prevent future sequelae.

La osteomielitis (OM) se define como la inflamación ósea de origen infeccioso. La forma aguda es frecuente en la edad pediátrica. El absceso de Brodie es un tipo de osteomielitis subaguda, históricamente con baja incidencia, pero que actualmente se presenta un aumento de la misma. De poca repercusión clínica, con pruebas de laboratorio inespecíficas y estudios radiológicos de difícil interpretación, es crucial la sospecha diagnóstica. Se asemeja a procesos neoplásicos, benignos o malignos. Recae en la experiencia del profesional realizar el diagnóstico adecuado. El tratamiento consiste en antibioticoterapia, tanto parenteral como por vía oral, y eventualmente drenaje quirúrgico. Presentamos una paciente sana que consultó por una tumoración en topografía de clavícula izquierda de 3 meses de evolución. Se realizó diagnóstico de absceso de Brodie, inició tratamiento y se obtuvo una buena respuesta. Resulta imprescindible tener un alto índice de sospecha de esta entidad para no someter al paciente a estudios, pruebas invasivas o tratamientos erróneos, y evitar secuelas a futuro.

Subacute osteomyelitis of the tibial diaphysis associated with Brodie's abscess: A rare case report of a four-year-old child.

INTRODUCTION: Septic osteomyelitis is a hematogenous bacterial bone infection. The acute presentation is the most common; the subacute one is less frequent. The aim of our case report is to put forward the features of this uncommon presentation and to propose a therapeutic management. PRESENTATION OF CASE: We report a rare case of subacute osteomyelitis associated with Brodie's abscess of the tibial diaphysis in a four-year-old child. The chief complaint was a pain in the left tibia evolving for five weeks. The radiological findings and the unusual location of this pathology suggested a malignant bone tumor. Thanks to imaging assessment and bone biopsy the diagnosis of subacute osteomyelitis associated with Brodie's abscess was made. Therefore, the child had antibiotic therapy and plaster immobilization to avoid pathological fracture. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal. DISCUSSION: We report an uncommon case of subacute osteomyelitis which evolved to Brodie's abscess with diaphyseal location. The mainstream treatment is surgery combined with antibiotics. However, medical treatment alone can lead to recovery without sequelae. CONCLUSION: Because of the atypical location and presentation of subacute osteomyelitis, the other differential diagnoses, especially malignant bone tumors have to be eliminated. In some cases, treatment may be based on antibiotics therapy alone.

Brodie's Abscess: A Diagnostic Conundrum.

Atraumatic limb pain in a child raises concerns in a medical setting. That is how a typical case of Brodie's abscess presents, having pain without any other symptoms of systemic illness. Assessment and investigations might also not reveal anything significant unless adequate imaging is done. Although Brodie's abscess has a very low rate of complications and morbidity/disability, it is important that such a presentation is assessed clinically with a diagnosis of Brodie's abscess in mind to ensure an uneventful and good outcome. We illustrate in this case report a similar presentation of an 11-year-old girl who had multiple visits to primary care. She was then assessed through radiological imaging. By the time of her diagnosis, her abscess had protruded through the skin. Thankfully management was done swiftly after identification and the final outcome was good with complete recovery.

Radiological changes in the formation of Brodie's abscess by sequential magnetic resonance imaging: a case report.

Brodie's abscess is a relatively rare subacute form of osteomyelitis. Early diagnosis is challenging because of its insidious onset and vague symptoms. Magnetic resonance imaging is helpful in the diagnosis of Brodie's abscess; however, to date, no study has described the imaging findings of this disease in the early stage. Here, we present the case of a 14 year-old boy with Brodie's abscess in the proximal tibia. The lesion initially presented as a bone marrow edema in the proximal metaphysis of the left tibia on MRI and was misinterpreted as a bone bruise. Further radiological examination was performed 1 month later; this revealed the formation of an abscess cavity, which suggested Brodie's abscess. The patient was referred to our hospital and underwent curettage and debridement, which led to the definitive diagnosis of Brodie's abscess on histopathological findings and bacterial culture. On careful retrospective evaluation, the initial radiological findings suggested a microabscess on the metaphyseal side of the growth plate and bone marrow edema spreading from the lesion to the epiphysis. These radiological changes could be reliable evidence proving that the metaphyseal side of the growth plate is the origin of Brodie's abscess. Moreover, bone marrow edema with suspected microabscess in the metaphysis of the long bones can be the initial stage of the formation of Brodie's abscess and should be carefully followed up.

Rare Intercondylar Distal Femoral Brodie's Abscess in a 21-Year-Old Man Who Refused Medical Care for Three Years after Initial Symptoms.

Brodie's abscess is a rare form of sub-acute osteomyelitis that implies the collection of pus inside bone tissue. The present paper presents an extremely rare case of Brodie's abscess located in the distal femur in a young male patient who refused medical care for three years and presented directly with spontaneous fistula and septic complications. Laboratory tests also suggested chronic septic alterations. Complex imaging investigations including X-ray (RX), computer tomography (CT) and Magnetic Resonance imaging (MRI) confirmed the diagnosis with characteristic aspects, such as the penumbra sign on the T1 weighted MRI image. Management included aggressive debridement, defect reconstruction, and long-term specific antibiotics according to culture harvested intra-operatively. Evolution was positive with inflammatory blood tests returning to physiological values within four weeks and patient full recovery within six months, without any physical deficits. The novelty aspect found in this case presentation is represented by the long-term natural evolution of this pathology, and the fact that even in these conditions, the Brodie's abscess did not evolve into a 'malignant' septic condition, but remained rather benign until the spontaneous fistula prompted the patient to seek medical care.

Brodie's Abscess Following Radiofrequency Ablation of an Atypical Osteoid Osteoma.

A 15 years old boy presented with an atypical osteoid osteoma (OO) in distal femur. He underwent radiofrequency ablation (RFA) elsewhere. He presented to our centre a year later with persisting pain. MR scan showed incomplete ablation of the nidus as there was only a single pass of the RF probe for a 14 mm long linear lesion. We also found penumbra sign and wall enhancement on contrast MRI suggestive of a Brodie's abscess (BA). Under CT guidance the OO was drilled and BA was saucerised. Following this he was treated with culture sensitive antibiotics and his symptoms resolved. BA and OO are common differential diagnoses. RFA of OO leading to BA has not been reported in literature. Atypical linear OO requires multiple probe placements to ablate the long nidus. Diligent care should be taken to avoid intraoperative contamination in CT room which could lead to infection.

Brodie's Abscess of the Proximal Humerus Metaphysis: A Case Report.

Introduction: Primary subacute pyogenic osteomyelitis, or Brodie's abscess was initially documented by Sir Benjamin Brodie in 1832. We present a case report with a 6-months follow-up period, demonstrating the successful diagnosis and surgical treatment of a focal lesion of the proximal metaphysis of the right humerus in a 21-years-old female. The pathology of hematologic osteomyelitis and its role in the development of a subacute abscess along with a review of literature and an in detail description of the pathogenesis of Brodie's abscess is discussed and submitted. Case Presentation: A 21- years -old healthy female with a history of fall sustaining injury to the right shoulder one 1 year back followed by which she presented to the outpatient clinic with a swelling over her right shoulder. The patient was managed conservatively with analgesics and was relieved of pain over a course of one 1 week of medications, the patient now presents with pain and swelling in the right shoulder joint on and off since the episode of fall one 1 year back, which had increased over a period of past one 1 week. A week before the most recent presentation she started experiencing some discomfort and pain in her right shoulder. No recent trauma was reported. A mild swelling appeared over the proximal part of the humerus. There were no constitutional symptoms of fever or any illness reported. On examination, there was noted a painful restriction of ROM at the right shoulder joint with no rotator cuff injury. Laboratory investigations were suggestive of raised inflammatory markers. Radiograph of the right shoulder taken in the true antero-posterior view with the shoulder in the neutral rotation was suggestive of an oval lucency with surrounding sclerosis in the proximal metaphyseal region of the humerus. Magnetic resonance imaging MRI of the right shoulder joint showed features consistent with Brodie's abscess in the proximal metaphyseal region of the humerus. Surgical debridement of the abscess was planned. The right shoulder of the patient was immobilized by a universal shoulder immobilizer for 3 days post -operatively and then Pphysiotherapy for shoulder range of movements was started. Infectious parameters decreased and there were no complications in the postoperative period. Regular follow follow-up for two 2 weeks showed clinical improvement. At 6 months follow- up, the patient had made full recovery with radiographic improvement. Conclusion: Brodie's abscess was first described by Sir Benjamin Brodie in 1832. Primary hematogenous subacute osteomyelitis is rarely seen in the proximal metaphysis of the humerus. With appropriate surgical debridement and aggressive antibiotic cover, a near 100% success rate is observed in the treatment of Brodie's abscess with no residual deformities in the affected bones or restrictions in the range of movements in the neighboring joints.

A Rare Case of Brodie's Abscess in HIV Patient Caused by Mycobacterium kansasii.

We report a rare case of Brodie's abscess caused by Mycobacterium kansasii (M. kansasii). Our patient is a 39-year-old male who presented with right foot pain a month after a new diagnosis of HIV infection. X-ray and MRI were done, and the diagnosis of Brodie's abscess was confirmed. Surgical debridement was done, and bone cultures grew M. kansasii after five weeks. Brodie's abscess is a subacute form of osteomyelitis usually caused by Staphylococcus. Some other bacteria have been implicated in several case reports. To best of our knowledge, this is the first case of Brodie's abscess caused by M. kansasii. M. kansasii is the atypical mycobacteria causing infections in immunocompromised hosts as in HIV patients with low CD4 count. M. kansasii is usually associated with lung infections with rare extrapulmonary manifestations as in our case.

A Case of Brodie's Abscess With Tibial Erosion and Extravasation Into Surrounding Soft Tissue.

Atraumatic limb pain and limp is a common pediatric presentation in the emergency department in the United States. In a majority of cases, these presentations are benign. However, in cases where pediatric patients are repeatedly presenting for atraumatic limb pain, further investigation is required. We present such the case of a 14-year-old female with acute worsening of progressive atraumatic knee pain who was found to have a Brodie's abscess, a subacute pyogenic form of osteomyelitis. This is a particularly challenging diagnosis, as it often presents with no associated symptoms such as fever or weight loss. The consequences of missing this diagnosis include permanent disability and potential amputation, but excellent outcomes can be expected for those who undergo timely surgical debridement and irrigation. We discuss the etiology, common presentations, and treatment of this rare but potentially limb-threatening disease in the hope that clinicians will consider this diagnosis in cases of persistent or progressive atraumatic limb pain.

Treatment for Brodie's abscess of the radius in an adolescent: A case report.

INTRODUCTION: Brodie's abscess is an uncommon type subacute osteomyelitis. It is typically localized in the metaphysis of tubular bones, particularly in the lower extremities. We herein report a rare case of the abscess appearing in the upper extremities. Furthermore, we successfully treated the large abscess without autogenous bone grafting. PRESENTATION OF CASE: 14-year-old female presented with pain and swelling on the right forearm. Plain radiograph and CT scan indicated a 10 cm longitudinal cortical bone hypertrophy and a well-defined radiolucent lesion in the diaphysis of the right radius. MRI demonstrated that the lesion was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging inside as well as outside the bone marrow of the radius. Laboratory data showed no inflammatory response, but Staphylococcus aureus was detected by biopsy. We diagnosed Brodie's abscess of the radius, and performed definitive surgery. Infected bone marrow was curetted and a bony sequestrum inside the cortical bone was harvested. We did not use autogenous bone grafting, since the upper extremities are areas of unloaded bone. Postoperative administration of antibiotics was subsequently performed. One year after surgery, the patient was asymptomatic and there were no complications or signs of infection recurrence. CONCLUSION: We diagnosed and surgically treated a rare case of Brodie's abscess of the radius in an adolescent. An abscess with large cavity is usually treated by curettage and autogenous cancellous bone grafting. However, since the upper extremities are areas of unloaded bone, we successfully treated the abscess by debridement without bone grafting.

Brodie's Abscess Masquerading as Vaso-occlusive Crisis in a Sickle-cell Disease Patient.

Brodie's abscess is a rare form of subacute osteomyelitis, most commonly found in children between the ages of two to fifteen years. It has slight preponderance for males. It is characterised by centrally placed, well-circumscribed abscess within the medulla or metaphysis of long bone, most commonly tibia, surrounded by a sclerotic wall. It is sometimes considered a transitional phase for the development of chronic osteomyelitis due to infection persisting between two to six months without showing any systemic symptoms specific to osteomyelitis. It is assumed that it is clinically quiescent due to its intraosseous location. It rarely presents with overt symptoms, which occurs if either the abscess enlarges to create pressure against the periosteum, or if the purulent material extrudes from the confines from its sclerotic walls. Due to subliminal clinical features and indolent clinical course, radiologic investigations are the diagnostic modality of choice. Diagnosis requires a high degree of suspicion, especially in the scenario of sepsis with an unknown source of infection. We describe a case of Brodie's abscess in a sickle-cell disease patient which presented as episodes of vaso-occlusive crisis repeatedly before it was diagnosed along with a review of the literature.