Abstract
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.
Highlights
Osteomyelitis historically has been categorized into acute, subacute, or chronic based on initial onset and presentation of the disease
It is often difficult to distinguish between subacute osteomyelitis and chronic osteomyelitis due to the absence of overt symptoms; Brodie’s abscess is even harder to diagnose and a delay is characteristically seen [2]
We report a case of Brodie’s abscess in a sickle-cell disease patient presenting with recurrent vaso-occlusive crisis due to underlying quiescent Brodie’s abscess
Summary
Osteomyelitis historically has been categorized into acute, subacute, or chronic based on initial onset and presentation of the disease. A 57-year-old African American gentleman with sickle-cell disease, hemoglobin-SS, avascular necrosis of the bilateral hip and right shoulder, with remote right shoulder replacement, presented to the emergency department complaining of pain in multiple large joints. Despite lack of fever and absence of clinical signs of infection (swelling, warmth, tenderness), the persistently elevated white blood cell (WBC) count with worsening right hip pain and weakness, was concerning. MRI of the right hip revealed lateral hip having peripherally enhancing soft tissue fluid collection extending into the right acetabular fossa and into the proximal femur, measuring approximately 5.3 x 14 x 20 cm enlarging soft tissue fluid collection (Figures 2-3) These areas had low signal intensity on T1weighted imaging and high signal intensity on fluid-sensitive sequences. These signals extended along the lateral aspect of the right hip with intraosseous femoral extension, alongside evidence of femoral and acetabular subacute osteomyelitis These radiological findings were consistent with Brodie’s abscess. The patient made a slow recovery thereafter and was discharged to a rehabilitation facility for recuperation
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