Osteomyelitis variolosa: Forgotten complication of an eradicated disease

Abstract

Background: Orthopedic manifestations and sequelae of small pox disease are largely forgotten. Presening features in the modern era are not only the classical deformities but also includes precocious arthritis, pathological fractures and joint instability. Objectives: To conduct a thorough and systematic review of the literature for all articles reporting osteomyelitis variolosa and its sequelae post eradication and to present an additional case as an illustration. Study design: Systematic review and case report. Method: ology: PubMed, EMBASE and Google Scholar databases were searched for relevant articles using different combinations of the keywords till 20th June 2017. All articles reporting cases of osteomyelitis variolosa following small pox eradication were included. Pearling of the bibliographies of selected articles was conducted to locate articles missed by the primary database search. Data from these reports were collected on pre-defined forms and the results were analysed. Results: A total of 8 cases have been reported in the literature so far post-eradication of small pox and all cases are from India. These cases have predominant involvement of elbow followed by hands, feet and ankle. Characteristic clinical signs in the present era are secondary arthritis, pathological fractures, joint instability and some cases even have incidental presentation. The diagnosis is further confirmed by plain radiographs which show pathognomonic features of this condition. Rate of missed/misdiagnosis is very high due to rarity of this condition. All cases in the published literature were managed conservatively except those presenting with pathological fracture. Conclusions: The purpose of this study is to remind clinicians of an easily recognised sequelae of an eradicated disease and make them aware of its complications.

Eptesipox virus-associated lesions in naturally infected big brown bats

“…Infection with certain species of poxviruses in specific hosts can result in a systemic infection with variable necrotizing or proliferative lesions in multiple internal organs, but this was not observed in these 2 cases. 27 , 35 Joint lesions, as seen in one of these cases, and as described in the initial EfPV report, have not been described in other poxviral infections, except for variola virus infections. Osteomyelitis variolosa is the term for this uncommon presentation of smallpox (variola) infection.…”

Osteomyelitis variolosa, an issue inherited from the past: case report and systematic review

“…3 ). Here, we present data from all cases of osteomyelitis variolosa [ 13 – 22 ]. We have combined the characteristics of the patients in the following paragraphs, and detailed data are available in the table below (Table 1 ).…”

“…The X-ray features of the elbow lesion in osteomyelitis variolosa were very diverse, mainly consisting of sclerosis of the peri-elbow bone, long slender flexuous shaft of the humerus, ulna and radial tuberosity, and dysplasia or enlargement of the distal humerus, olecranon and radial head. Alternatively, the articular space of the elbow is reduced, the joint is misshaped or dislocated, and the proximal radius and ulna are fused [ 13 – 20 , 22 ]. The elongated medial and lateral condyles of the humerus are visible in some patients [ 13 ], and a significantly lengthened humeral ectocondyle has also been seen in unearthed human medieval remains [ 25 ].…”

“…For elbow sequelae triggered by osteomyelitis variolosa, flexion deformities and activity limitations are the most frequent problems [ 14 , 16 , 17 , 19 – 22 ]. Although some patients have exaggerated clinical deformities and imaging abnormalities of the elbow, joint function is not obviously limited, and they are still able to perform manual labor and lift heavy weights using both upper limbs [ 20 , 22 ].…”

“…For elbow sequelae triggered by osteomyelitis variolosa, flexion deformities and activity limitations are the most frequent problems [ 14 , 16 , 17 , 19 – 22 ]. Although some patients have exaggerated clinical deformities and imaging abnormalities of the elbow, joint function is not obviously limited, and they are still able to perform manual labor and lift heavy weights using both upper limbs [ 20 , 22 ]. A patient with elbow flexion deformities developed right acute cubital tunnel syndrome and was treated with surgical excision of the ganglion, release of the cubital tunnel retinaculum, and anterior transposition of the ulnar nerve, which resulted in the effective improvement of ulnar nerve function [ 19 ].…”