Sacral florid reactive periostitis: a case report

Florid reactive periostitis is a rare benign periosteal lesion predominantly affecting short tubular bones of the hands and feet, with only occasional reports in long bones. This case study discusses the clinical diagnosis and treatment of a patient with extremely rare florid reactive periostitis involving the sacrum.

A 12-year-old Chinese female presented with unexplained sacrococcygeal pain and swelling. Comprehensive evaluation included computed tomography/magnetic resonance imaging, histopathological analysis, and immunohistochemistry (SATB2:+, p53: weak + , Ki-67: 60%). USP6 gene fluorescence in situ hybridization (FISH) testing was performed to exclude malignancy. Imaging revealed expansive bone destruction with periosteal reaction and soft tissue edema, initially suspicious for malignancy. Pathological examination confirmed florid reactive periostitis, characterized by fibroblastic proliferation, osteoid formation, and chronic inflammation. Conservative treatment (nonsteroidal anti-inflammatory drugs (NSAIDs) and immobilization) led to significant symptom resolution and radiographic improvement at 2-month follow-up.

This case expands the anatomical spectrum of florid reactive periostitis to include the sacrum. Diagnosis requires multidisciplinary correlation of clinical, imaging, and pathological findings to differentiate florid reactive periostitis from malignant lesions. Conservative management may be effective for symptomatic sacral florid reactive periostitis.