Mayorga-Naranjo D, Ortega-Yago A, Baixauli-García I, Argüelles-Linares F, Baeza-Oliete J

Language: Spanish
References: 13
Page: 56-60
PDF size: 926.20 Kb.

ABSTRACT

Introduction: Garré's sclerosing osteomyelitis is a chronic inflammatory condition of the bone without overt clinical signs of infection, characterized by hyperplastic periostitis and cortical thickening. It typically affects long bones in young patients, with humeral involvement being exceptionally rare. The aim of this report is to present a humeral case and review the relevant literature. Case report: a 12-year-old girl presented with right shoulder pain following a fall. Initial radiographs revealed a metaphyseal lytic lesion with cortical thinning and periosteal reaction. MRI showed cortical thickening and soft tissue edema without abscess formation. The initial biopsy suggested a chondroma, leading to intralesional excision. Histopathological analysis ruled out neoplasia and confirmed acute osteomyelitis. Due to persistent pain and radiographic worsening, bone drilling was performed, revealing chronic inflammation and detection of Kingella kingae DNA. Seven years later, the patient experienced a relapse. Surgical treatment included a cortical window, curettage, and filling with Stimulans. Biopsy confirmed Garré's sclerosing osteomyelitis. Seven months later, the procedure was repeated with bioactive glass. Cultures were negative on both occasions. Intravenous and oral antibiotic therapy was administered, with a favorable clinical outcome. Conclusions: the diagnosis of Garré's osteomyelitis is challenging due to its nonspecific clinical presentation and negative cultures. Management requires combined surgical and antibiotic treatment, with a risk of recurrence and the need for long-term follow-up.

REFERENCES

1. Sanchez-Fernandez H, Claudio-Marcano A, Gonzalez-Ugarte M, Ramírez-Lluch N, Bibiloni J. Garré's sclerosing osteomyelitis of the tibia in a hispanic adult male: a case report. Cureus. 2024; 16(4): e57837.

2. De Moraes FB, Motta TM, Severin AA, de Alencar Faria D, de Oliveira César F, de Souza Carneiro S. Garré's sclerosing osteomyelitis: case report. Rev Bras Ortop. 2014; 49(4): 401-4.

3. Ghazali FR, Samsudin AHZ. Sclerosing Osteomyelitis of Garré: a clinico-radiological correlation. Cureus. 2022; 14(7): e26866.

4. Kadish LJ, Muller CJ, Mezger H. Chronic sclerosing osteomyelitis in a long bone caused by actinomycosis. A case report. S Afr Med J. 1982; 62(18): 658-9.

5. Nikomarov D, Zaidman M, Katzman A, Keren Y, Eidelman M. New treatment option for sclerosing osteomyelitis of Garré. J Pediatr Orthop B. 2013; 22(6): 577-82.

6. Kaushik K, Pundkare GT, Tawde A, A K. A rare case of Garre's osteomyelitis of tibia in an adult. Cureus. 2024; 16(2): e54034.

7. Vannet NB, Williams HLM, Healy B, Morgan-Jones R. Sclerosing osteomyelitis of Garré: management of femoral pain by intramedullary nailing. BMJ Case Rep. 2014; 2014: bcr2014206533.

8. Schwartz AJ, Jones NF, Seeger LL, Nelson SD, Eckardt JJ. Chronic sclerosing osteomyelitis treated with wide resection and vascularized fibular autograft: a case report. Am J Orthop (Belle Mead NJ). 2010; 39(3): E28-32.

9. Calamita AG, Stimolo D, Puccini S, Innocenti M, Campanacci DA. Garrè sclerosing osteomyelitis of the clavicle: clinical results after clavicular resection. Healthcare (Basel). 2024; 12(2): 202.

10. Pan K, Chan W, Ong G, Zulqarnaen M, Norlida D. Non-bacterial chronic recurrent osteomyelitis of the clavicle. Malays Orthop J. 2012; 6(1): 57-60.

11. Kelkar AS, Malshikare VA. Chronic sclerosing osteomyelitis of a metacarpal. J Hand Surg Br. 2005; 30(3): 298-301.

12. Yamazaki Y, Satoh C, Ishikawa M, Notani K, Nomura K, Kitagawa Y. Remarkable response of juvenile diffuse sclerosing osteomyelitis of mandible to pamidronate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104(1): 67-71.

13. Hallmer F, Korduner M, Moystad A, Bjornland T. Treatment of diffuse sclerosing osteomyelitis of the jaw with denosumab shows remarkable results-A report of two cases. Clin Case Rep. 2018; 6(12): 2434-7.