Τίτλος:
Chronic Osteomyelitis With Proliferative Periostitis of the Mandible in
a Child Report of a Case Managed by Immunosuppressive Treatment
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Osteomyelitis with proliferative periostitis is a relatively
uncommon inflammatory condition of the jaws, mainly characterized by
periosteal formation of reactive bone. It primarily affects children and
adolescences, also referred to as Garre's osteomyelitis, more frequently
involving the molar region of the mandible. Cases lacking an obvious
source of infection may have an immunologically mediated
etiopathogenesis, falling under the spectrum of primary chronic
osteomyelitis or chronic recurrent multifocal osteomyelitis (CRMO).
Case report: Herein, we present a case of chronic osteomyelitis in a
6.5-year-old girl, who suffered from recurrent painful episodes of
swelling of the mandible for the last 2 years, previously requiring
hospitalization and administration of intravenous (IV) antibiotics and
NSAIDs with limited responsiveness. The biopsy showed features
consistent with osteomyelitis with proliferative periostitis. The
patient was initially managed with an IV combination antibiotic regimen
with only partial improvement. The possibility of an autoimmune
mechanism in the context of primary chronic osteomyelitis or CRMO was
considered, and immunosuppressive therapy (TNF inhibitor etanercept
along with corticosteroids and methotrexate) was administered, resulting
in clinical resolution.
Conclusions: Osteomyelitis and its childhood variants are relatively
rare and their management presents several challenges. Although
typically treated with administration of antibiotics, possibly along
with surgical intervention, other treatment modalities may be necessary
for resilient and persistent cases. In a subset of cases, especially in
the absence of local infectious factors, immunologically mediated
mechanisms may play an important role and appropriate immunosuppressive
therapy may be effective.
Συγγραφείς:
Georgaki, Maria
Delli, Konstantina
Paschalidi, Polytimi and
Gkizani, Sotiria
Tsiklakis, Konstantinos
Nikitakis, Nikolaos G.
Περιοδικό:
The Pediatric Infectious Disease Journal
Εκδότης:
Lippincott, Williams & Wilkins
Λέξεις-κλειδιά:
osteomyelitis with proliferative periostitis; primary chronic
osteomyelitis; chronic recurrent multifocal osteomyelitis;
immunosuppressive therapy; anti-TNF
DOI:
10.1097/INF.0000000000003368
