Rapidly progressing osteomyelitis of the mandible

Area of Science:

• Oral and Maxillofacial Surgery
• Infectious Diseases
• Pathology

Background:

• Acute osteomyelitis is a challenging bone infection, often presenting with systemic and local signs.
• Atypical presentations can occur, particularly in immunocompromised individuals.
• Liver cirrhosis can impair immune surveillance and alter metabolism, potentially influencing infection progression.

Purpose of the Study:

• To describe a unique case of rapidly progressing acute osteomyelitis of the mandible.
• To investigate the role of actinomycotic elements in an atypical presentation of osteomyelitis.
• To highlight the challenges in diagnosing and managing refractory bone infections in patients with comorbidities.

Main Methods:

• Case report of a patient with acute osteomyelitis of the mandible.
• Clinical examination and imaging to assess disease progression.
• Microscopic analysis of sequestrum for identification of pathogens, including actinomycotic druses and filaments.

Main Results:

• The patient presented with rapidly progressing mandibular osteomyelitis without typical systemic or local symptoms.
• Actinomycotic druses and filaments were identified within the bone sequestrum.
• No local recurrence was observed 24 months post-surgery.

Conclusions:

• Actinomycotic elements may contribute to the rapid and atypical progression of osteomyelitis.
• Liver cirrhosis is a significant systemic factor influencing immune response in osteomyelitis.
• Early diagnosis and appropriate management are crucial for refractory osteomyelitis, even in atypical cases.