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

Abstract

Brodie's abscess is a rare form of subacute osteomyelitis, most commonly found in children between the ages of two to fifteen years. It has slight preponderance for males. It is characterised by centrally placed, well-circumscribed abscess within the medulla or metaphysis of long bone, most commonly tibia, surrounded by a sclerotic wall. It is sometimes considered a transitional phase for the development of chronic osteomyelitis due to infection persisting between two to six months without showing any systemic symptoms specific to osteomyelitis. It is assumed that it is clinically quiescent due to its intraosseous location. It rarely presents with overt symptoms, which occurs if either the abscess enlarges to create pressure against the periosteum, or if the purulent material extrudes from the confines from its sclerotic walls. Due to subliminal clinical features and indolent clinical course, radiologic investigations are the diagnostic modality of choice. Diagnosis requires a high degree of suspicion, especially in the scenario of sepsis with an unknown source of infection. We describe a case of Brodie's abscess in a sickle-cell disease patient which presented as episodes of vaso-occlusive crisis repeatedly before it was diagnosed along with a review of the literature.

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

“…However, this has to be done after complete eradication of the infection. 1 , 4 As the thickened sclerotic margin of the Brodies abscess can limit the infection from spreading into the bone stream, the systemic symptoms might be delayed or absent, which can be confused with a vaso-occlusive crisis. 1 Although uncommon in sickle cell patients, there are a few reports in the literature for Brodie’s abscess identified in sickle cell patients and only a couple of reports of Brodie’s abscess initially thought to be an acute sick cell crisis.…”

“… 1 , 4 As the thickened sclerotic margin of the Brodies abscess can limit the infection from spreading into the bone stream, the systemic symptoms might be delayed or absent, which can be confused with a vaso-occlusive crisis. 1 Although uncommon in sickle cell patients, there are a few reports in the literature for Brodie’s abscess identified in sickle cell patients and only a couple of reports of Brodie’s abscess initially thought to be an acute sick cell crisis. 11 A recent systematic review of reported cases in 2019 notes that publications of Brodie’s abscess are predominantly from developed countries 12 ; this may represent a deficiency in the reporting of instances of Brodie’s abscess among developing countries where sickle cell disease is more prevalent.…”

“… 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. 1 The clinical symptoms can be challenging, and a high degree of suspicion with appropriate imaging is crucial in a timely diagnosis.…”

“… 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. 1 The clinical symptoms can be challenging, and a high degree of suspicion with appropriate imaging is crucial in a timely diagnosis. We describe an intriguing case of Brodie’s abscess in a 19-year-old male initially attributed to a sickle cell vaso-occlusive crisis.…”

Radiofrequency Ablation (RFA) for Osteoid Osteoma in an 11-Year-Old Male Child With Sickle Cell Trait: A Case Report

“…Patients with sickle cell anaemia often present with bone pain and vascular complications, which can obscure the symptoms of coexisting musculoskeletal conditions. The diagnostic difficulty is exacerbated by overlapping clinical symptoms and radiologic findings, requiring a high level of suspicion and a thorough diagnostic assessment [ 4 ].…”