DIFFUSE SCLEROSING OSTEOMYELITIS TREATED WITH METHOTREXATE: CASE REPORT

Abstract

Diffuse sclerosing osteomyelitis (DSO) affects adults, exhibits no gender predilection, and often occurs in the jawbone. A 20-year-old male patient presented to our service with "facial pain" and mandibular asymmetry caused by a bone enlargement in the right side. Computerized tomography (CT) scanning showed large, mixed radiolucent and radiopaque areas associated with bone erosions from mandibular condyle to ipsilateral body. Culture and antibiogram analysis were negative. Histopathologic examination demonstrated unspecified bone inflammation signs. After review of the literature, the patient was referred to a rheumatologist and methotrexate in combination with folic acid was initiated on a weekly basis. The patient reports progressive reduction of pain although facial asymmetry still persists. Diagnosis of DSO may be challenging due to nonspecific findings and rarity of the disease. Fibrous dysplasia should be ruled out. Diffuse sclerosing osteomyelitis (DSO) affects adults, exhibits no gender predilection, and often occurs in the jawbone. A 20-year-old male patient presented to our service with "facial pain" and mandibular asymmetry caused by a bone enlargement in the right side. Computerized tomography (CT) scanning showed large, mixed radiolucent and radiopaque areas associated with bone erosions from mandibular condyle to ipsilateral body. Culture and antibiogram analysis were negative. Histopathologic examination demonstrated unspecified bone inflammation signs. After review of the literature, the patient was referred to a rheumatologist and methotrexate in combination with folic acid was initiated on a weekly basis. The patient reports progressive reduction of pain although facial asymmetry still persists. Diagnosis of DSO may be challenging due to nonspecific findings and rarity of the disease. Fibrous dysplasia should be ruled out.