Xanthogranulomatous Osteomyelitis of the Tibia

Abstract

Background: Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory process that is histologically characterized by the presence of foamy macrophages, histiocytes, and plasma cells. Radiologic and gross examinations can mimic malignancy, so definitive diagnosis should be made by histopathologic evaluation. Case Report: A 15-year-old male presented with pain in the proximal right leg for 2 weeks prior to admission. The patient had a history of leg trauma 3 years prior that was responsive to as-needed analgesics. Laboratory data revealed increased erythrocyte sedimentation rate and C-reactive protein. X-ray of the right tibia showed a periosteal reaction and bulging of bone with a questionable destruction of the cortex. Magnetic resonance imaging demonstrated an expansile bony lesion in the proximal metaphysis of the tibia. Histopathologic examination showed the bone trabecula surrounded by chronic inflammatory cells and a fragment of dead bone surrounded by histiocytes, foamy macrophages, and plasma cells. The pathologist confirmed the diagnosis of XO. Wound culture proved moderate growth of Staphylococcus aureus, and treatment with cefazolin and cephalexin was successful. Conclusion: The patient was not treated with the routine therapy used in previously reported cases (curettage), suggesting that antibiotic therapy should be considered before employing surgical interventions for XO.

Xanthogranulomatous osteomyelitis of Tibia in a case of 43 years old male patient: A rare entity diagnosed in a tertiary care hospital

“…Borijan et al 2 reported a multifocal case of xanthogranulomatous osteomyelitis in a 14 years old Afgan male, involving the humerus and the fibula. Kamat et al 3 and Solooki et al 4 have described two similar cases involving distal part of tibia, in a 13 year and 15 year old boy, respectively.…”

Temporal Bone Osteomyelitis Masquerading as Malignancy: A Diagnostic Challenge

“…In 2019, Solooki et al 9 published a case report and review of literature of 20 cases of XO, all in long bones, along with their own case. The most common bones involved were the tibia (8), femur (5), rib (3), humerus (3), and ulna (2).…”

Focal Xanthogranulomatous Pyelonephritis on FDG PET/CT

“…Xanthogranulomatous inflammation is a chronic inflammatory disease that can occur in many organs 1–3 . The medical image findings generally present as a mass-like lesion, and surgical resection was the most common treatment 1 . Xanthogranulomatous pyelonephritis is an uncommon disease that often combined with staghorn calculus and chronic suppurative renal inflammation 4 .…”

“…Instead, the cyst was covered by the foamy cells mixed with polymorphonuclear leukocytes and activated plasma cells, which was consistent with xanthogranulomatous pyelonephritis. Xanthogranulomatous inflammation is a chronic inflammatory disease that can occur in many organs 1–3 . The medical image findings generally present as a mass-like lesion, and surgical resection was the most common treatment 1 .…”

“…[1][2][3] The medical image findings generally present as a mass-like lesion, and surgical resection was the most common treatment. 1 Xanthogranulomatous pyelonephritis is an uncommon disease that often combined with staghorn calculus and chronic suppurative renal inflammation. 4 The imaging features can be ambiguous, earning the title of "the great imitator."…”