Die primär subakute hämatogene Osteomyelitis im Kindesalter

Abstract

The most frequent form of bone infection is haematogenous osteomyelitis (HOM), typically affecting infants and children. Dependent on the virulence of the pathogen and the patients immune response, one can distinguish between the acute (AHOM) and primary subacute haematogenous osteomyelitis (PSHO). In contrast to AHOM, diagnosis of PSHO is severely impeded in that clinical and blood-chemistry findings usually do not enable differentiation from primary malignant bone tumors. With a comparable age predilection and clinical symptoms, as well as very similar conventional radiographic, MRI- and bone-scan-findings, the most important differential diagnosis is Ewing's-sarcoma. The here demonstrated case of a 12 year-old girl shows that PSHA may imitate a sarcoma very closely, even concerning such usually fairly reliable radiographic aspects like osteolysis and lamellar periostal bone reaction. Despite the use of MRI, the diagnosis initially remained uncertain and a malignant bony lesion could only be ruled out after open biopsy and histopathological evaluation.