Bone infarction not associated with Caisson disease: a case report.

Abstract

Infarction of bone is a well-known complication of decompression sickness and sickle-cell anaemia (Kahlstrom, Burton and Phemister, 1939; Dahlin, 1967), but its cause may be obscure, particularly when it develops in the femoral head (Fisher and Bickel, 1971). Spontaneous infarction can, however, occur in one or more of a variety of long bones (Kahlstrom and Phemister, 1946), is sometimes associated with local pain and may eventually be identified radiologically as an irregular area of medullary sclerosis (Simon, 1968, Kahlstrom, 1942; Bullough et al., 1965). Bone infarcts can therefore be mistaken for calcifying cartilaginous neoplasm (Jaffe, 1961) and acute osteomyelitis. The case described here shows these characteristic changes in the tibia of a patient with chronic renal failure. In its initial stages the episode of infarction resembled osteomyelitis. Although the bone changes bore no resemblance to renal osteodystrophy, chronic renal failure may not have been wholly incidental in the cause of infarction. G.S., date of birth September 9, 1948. This patient, 21 years old on admission, a known case of chronic glomerulonephritis, presented with a history of a painful hard swelling situated over the shaft of the right tibia. This developed rapidly four weeks before admission to hospital and one week after an accident in which he fell and twisted his ankle. The lesion did not respond to oral broadspectrum antibiotics, nor to intramuscular penicillin given for a concomitant sinusitis.