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

Abstract

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.