MMB (025) Practical of Bone Infections “Osteomyelitis”

Question 1

What’s Osteomyelitis

Answer 1

Inflammation of bone and bone marrow

Question 2

Answer 2

Question 3

1. What is your provisional diagnosis?

Answer 3

Osteomyelitis

Question 4

2- Describe the radiography

Answer 4

A central area of osteolytic lesion with a surrounding thick rim of reactive bone sclerosis

Question 5

3- Mention the investigations required to confirm your diagnosis.

Answer 5

• Blood culture ( positive for microorganisms)

• Aspiration biopsy at the point of maximal tenderness using a large core needle&raquo_space; pus is aspirated and culture of pus is positive for microorganisms

• Definite diagnosis: intra-operative biopsy (heavy leukocytic infiltrate with necrotic bony remnants & a subperiosteal abscess)

Question 6

Mrs. Nadia is a 72 year old diabetic woman. She has osteoarthritis. Her daughter noticed that her mother is feverish for a week. After 3 weeks, Mrs. Nadia has redness and swelling below her knee joint.

4- If biopsy is performed, describe the microscopic picture.

Answer 6

-Acute inflammatory cells

-Necrotic bony fragments surrounded by fibrosis& inflammatory infiltrate

Question 7

Answer 7

Brodie’s Abscess

Question 8

What is Brodie’s Abscess ?

Answer 8

Brodie’s abscess is a form of chronic pyogenic osteomyelitis that usually affects the cancellous part of the long bones in children

Question 9

Garre’s sclerosing osteomyelitis ?

Answer 9

A type of osteomyelitis typically develops in the jaw and is characterized by extensive new bone formation

Question 10

A 70-years old man with diabetes presents with intractable back pain. He is treated as acute disc prolapse. This pain has worsened and he is now paraplegic. An MRI performed shows destruction of two adjacent thoracic vertebrae. A biopsy is taken.

• What is the most likely diagnosis?

Answer 10

Pott’s disease

Question 11

A 70-years old man with diabetes presents with intractable back pain. He is treated as acute disc prolapse. This pain has worsened and he is now paraplegic. An MRI performed shows destruction of two adjacent thoracic vertebrae. A biopsy is taken.

How did Mycobacterium tuberculosis reach the vertebrae?

Answer 11

• Mycobacterium tuberculosis spread to the vertebrae via the haematogenous route

Question 12

Answer 12

Question 13

Answer 13

Question 14

Common sites of tuberculous osteomyelitis ?

Answer 14

-Ends of long bones

-Vertebrae (Pott’s disease)

Question 15

Mention two rare sites of tuberculous osteomyelitis

Answer 15

-Flat bones (as ribs & pelvis)

-Short bones of hands and feet