Acute leg pain with suspected beginning leg compartment syndrome and deep vein thrombosis as differential diagnoses in an unusual presentation of Brodie’s abscess: a case report

Abstract

BackgroundBrodie’s abscess is an uncommon form of subacute osteomyelitis where the main presenting symptom is mild to moderate pain of insidious onset for several months’ duration. We report a case of a patient presenting with acute leg pain resembling that of a deep vein thrombosis, and a beginning leg compartment syndrome following a suspected ruptured Baker’s cyst. Our case is unusual because of the acute presentation of the Brodie’s abscess with acute leg pain and acute swelling without any preceding trauma; to the best of our knowledge, this presentation has not been reported before.Case presentationA 17-year-old white boy presented to our out-patient clinic with a 6-month history of pain in his left knee joint of insidious onset. There was no history of trauma to the extremity. After performing physical and radiological (X-ray) examinations, we initially diagnosed medial meniscus damage. One week later he presented to our emergency department with acute sudden increase in the pain and swelling of his left knee, and pain and swelling of his left leg, without any trauma. Deep vein thrombosis and beginning leg compartment syndrome from ruptured Baker’s cyst were initially diagnosed. Magnetic resonance imaging was performed and Brodie’s abscess was the most probable diagnosis. We performed open surgical debridement and curettage with drainage of the abscess and administered postoperative antibiotics. He presented to our out-patient clinic 3 months postoperatively, where he was pain-free with no residual local tenderness.ConclusionsIn cases of sudden acute increase in joint or extremity pain or swelling that has been insidiously present for months, Brodie’s abscess should be considered as one of the differential diagnoses, as it may present acutely in cases with accompanying fasciitis and myositis and be clinically mistaken for deep vein thrombosis or limb compartment. Magnetic resonance imaging remains the gold standard imaging study, and surgical treatment followed by postoperative antibiotics remains the standard treatment.

Brodie’s Abscess Masquerading as Vaso-occlusive Crisis in a Sickle-cell Disease Patient

“…This is hypothesized to be when the integrity of the sclerotic rim of bone is unable to contain the abscess and the contents reach beyond the confines of the sequestered infection [7]. Our patient presented with negative blood cultures, a normal WBC, and elevation of CRP and ESR [1].…”

“…Brodie's abscess is a rare form of subacute osteomyelitis, leading to a centrally-placed, wellcircumscribed abscess, surrounded by a sclerotic wall [1]. It is characterized by infection suspected to have persisted between two to six months without showing any systemic symptoms specific to osteomyelitis.…”

“…It has a predilection for developing in the metaphysis of long bones. Classically, extremities are more often involved due to the presence of end arteries in the metaphysis of long bones, with the tibia being the most common target followed by the femur [1]. However, other smaller bones lacking a proper metaphysis are also reported to have been involved [4].…”

A Rare Case of Brodie’s Abscess in the Tibial Diaphysis Masquerading as a Vaso-occlusive Sickle Crisis

“…The spread of bacteria is usually hematogenous, with Staphylococcus aureus being the most common organism. 3 Patients with sickle cell disease are more likely to develop osteomyelitis, with a lifetime prevalence of up to 12 %. 1 Hyposplenism, impaired complement activity, and infarcted bone predispose sick cell disease patients to avascular necrosis, creating a nidus that increases the risk of infection.…”