Thread by @guerreroespejo

18-YO👨‍🦱: painful tender, fluctuant mass mass over the R anterior sin, chronic right knee pain, weight loss.

Leukocytosis
⬆️inflammatory markers (ESR, CRP)

XR & MR: ?
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doi.org/10.1093/cid/ci…
#Orthopedics #radiology #MedEd

X-ray: areas of lucency & sclerosis in the proximal tibial metadiaphysis
MR: consistent with an chronic osteomyelitis & intraosseous abscess with myositis involving the adjacent musculature

A presumptive diagnosis of BRODIE ABSCESS
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#IDtwitter #MedTwitter

Debridement with sequestrectomy
3 deep bone: Aggregatibacter aphrophilus
🔬: bone remodeling, fibrosis, & mixed lymphoplasmacytic & histiocytic infiltrates

BRODIE ABSCESS OF THE TIBIA DUE TO AGGREGATIBACTER APHROPHILUS
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doi.org/10.1093/cid/ci…
#microbiology #Doctor

Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus):
- facultative anaerobic small G➖bacillus
- colonize the oral cavity
-implicated in HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) endocarditis & brain abscesses
- rare bone infections
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BRODIE ABSCESS:
- most frequent pathogen, S. aureus
- usually chronic pain over several months to years
- but can present with a draining abscess extending from the bone out
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#MedStudentTwitter #MedicalStudents

Brodie abscesses are best visualized by computed tomography and can present as an oval or elliptical radiolucency usually >1 cm surrounded by heavy sclerosis.
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#resident #medicine

Treatment of Brodie abscesses usually requires both surgical and medical interventions

Although this isolate was susceptible to β-lactam antimicrobials, the patient was treated with oral ciprofloxacin due to prior experience in treating osteomyelitis due to A. aphrophilus
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The patient completed a 3-month course of antimicrobial therapy due to concerns from the orthopedic surgeon that only a limited debridement was performed.
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doi.org/10.1093/cid/ci…

At the 5-month postdebridement follow-up, there was ongoing radiologic improvement & no evidence of clinical relapse.

The patient continues to be followed up & has demonstrated no relapse 10 months after debridement (7 months following completion of ciprofloxacin).
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#MedEd