OSTEOMIELITIS DE TIBIA PROXIMAL POR SALMONELLA GRUPO B EN UN PACIENTE JOVEN INMUNOCOMPETENT

A. DARÁS BALLESTER, F. Bonilla Enseñat, C. de la Calva Ceinos, M. Fuertes Lanzuela
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Abstract

Our objective is to present a case of proximal tibial osteomyelitis due to Salmonella, which is infrequent in clinical practice, as well as to analyze the procedures carried out for its treatment, and the differential diagnosis of the lesion. Clinical case: A 13-year-old male referred from another Hospital to our Hospital Children's Oncology due to a suspicion of a bone tumor in the tibia. The patient reported two-week history of knee pain associated with fever. In the radiographs taken at his center, a lytic lesion was observed in the proximal metaphysis of the tibia, which led to the performance of a Magnetic Resonance Imaging (MRI). After reviewing the MRI images in our center, the neoplastic nature of the lesion was ruled out and the suspected diagnosis was an Osteomyelitis, after which the patient underwent surgery, being performed a corticotomy and emptying of the abscess and initiating intravenous antibiotic treatment. The patient had an unremarkable postoperative course and in the culture of the extracted material Salmonella group B was obtained. The patient was controlled with oral antibiotic, and was definitively discharged two years after the intervention. However, 3 years after that, he came to Hospital with similar symptoms. After performing some imaging tests, two multiloculated lytic lesions were observed in the proximal tibia with a perilesional inflammatory reaction, suggestive of recurrence of Osteomyelitis, for which he underwent surgery again, performing a bone window and curettage, and filling the cavity with tricalcium sulfate and antibiotic. The cultures taken were again positive for Salmonella B. After the patient's clinical and analytical progress was correct, he was treated with oral antibiotics, and was definitively discharged two years after the intervention. Conclusion: Salmonella osteomyelitis in immunocompetent patients is a rare pathology that can simulate a neoplastic lesion if it is found in an atypical location such as metaphysis. The diagnosis must be clinical, radiological and analytical, although the definitive diagnosis will be achieved by cultures results. The definitive treatment is curettage and filling the lesion, associated with antibiotic therapy, and it is necessary to take into account that the lesion may recur.
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一名免疫能力强的年轻患者胫骨近端沙门氏菌B组骨髓炎
我们的目的是提出一例因沙门氏菌引起的胫骨近端骨髓炎,这在临床实践中并不常见,并分析其治疗的程序,以及病变的鉴别诊断。临床病例:一名13岁男性,因怀疑胫骨骨肿瘤,从外院转至我院儿童肿瘤科。患者报告两周膝关节疼痛伴发热病史。在他的中心拍摄的x线片中,在胫骨近端干骺端观察到溶解性病变,这导致了磁共振成像(MRI)的表现。在我中心复查MRI影像后,排除病变的肿瘤性质,怀疑诊断为骨髓炎,患者接受手术治疗,行皮质切开术,脓肿排空,并开始静脉抗生素治疗。患者术后病程无明显变化,提取物培养中获得B组沙门氏菌。患者口服抗生素控制,干预两年后最终出院。然而,3年后,他以类似的症状来到医院。在进行一些影像学检查后,在胫骨近端观察到两个多室溶解性病变,伴有病灶周围炎症反应,提示骨髓炎复发,为此他再次接受手术,进行骨窗和刮除,并用硫酸钙和抗生素填充腔。在病人的临床和分析进展正确后,他接受了口服抗生素治疗,并在干预两年后最终出院。结论:沙门氏菌骨髓炎在免疫功能正常的患者中是一种罕见的病理,如果发现在非典型部位,如干骺端,可以模拟肿瘤病变。诊断必须是临床,放射学和分析,虽然最终的诊断将通过培养结果实现。最终的治疗是刮除和填充病变,结合抗生素治疗,有必要考虑到病变可能复发。
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