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[Osteomyelitis in the pagetic tibia]
J C Rénier1, L Pidhorz, F Parvery
1Service de Rhumatologie, CHU Angers.
Abstract:
Osteomyelitis developing in pagetic bone is a very rare event, of which only one instance has been reported to date, in a patient with mandibular disease. We have managed three patients with osteomyelitis of a pagetic tibia. The portal of entry was a skin lesion in all three cases. A Gram-negative organism was found in all three cases and was associated with the anaerobe Bacteroides melaninogenicus in one case. One of the patients was lost to follow up before eradication of the infection. Amputation was required in the other two after unsuccessful antimicrobial therapy for 23 and four years, respectively.
Insights
Osteomyelitis in Paget's bone is rare. This study details three cases of tibia osteomyelitis in Paget's disease patients, often requiring amputation due to persistent infection.
Area of Science:
- Orthopedics
- Infectious Diseases
- Bone Metabolism
Background:
- Paget's disease of bone is a chronic condition characterized by abnormal bone remodeling.
- Osteomyelitis, a bone infection, is an exceptionally rare complication in patients with Paget's disease.
- Previous literature documented only one case of osteomyelitis in pagetic bone.
Observation:
- This report details the management of three patients presenting with osteomyelitis specifically affecting the tibia in the context of Paget's disease.
- In all three cases, the initial point of infection was a cutaneous lesion.
- Microbiological analysis identified Gram-negative organisms in all patients, with one case also involving the anaerobe Bacteroides melaninogenicus.
Findings:
- Despite treatment, one patient was lost to follow-up before infection resolution.
- Two patients ultimately required amputation of the affected limb due to persistent infection, following extensive antimicrobial therapy lasting 23 and 4 years, respectively.
- The findings highlight the challenges in treating osteomyelitis in the unique context of pagetic bone.
Implications:
- This study underscores the rarity and significant morbidity associated with osteomyelitis in Paget's disease.
- Effective management strategies for this rare complication remain critical.
- Further research may be needed to explore optimal treatment protocols for osteomyelitis in pagetic bone to prevent severe outcomes like amputation.