An uncommon case of septic cortical osteitis

A 39-year-old healthy female patient with an unremarkable medical history complained about a rapidly progressive pain for a period of 1 month at the level of the anterior part of the right leg that was not relieved by NSAIDs. She mentioned only that she resumed her high level sport training 6 months before the onset of the symptoms. There was no specific history of trauma, fever, or other distinctive symptoms. On clinical examination, the right pretibial skin was inflamed and extremely painful. Walking became difficult the last 2 weeks. No skin injury was observed on the right leg and foot. The early blood tests, consistent with moderate aspecific inflammation, showed a slightly elevated C-reactive protein and sedimentation rate, without any leukocytosis. Upon first consultation the plain radiographs of the right leg were normal, but control radiographs obtained 2 weeks later showed cortical and lamellar lucencies of the right tibial crest.