de Moraes Frederico Barra, Motta Tainá Melo Vieira, Severin Alessandra Assis, de Alencar Faria Deniel, de Oliveira César Fernanda, de Souza Carneiro Siderlei
Department of Orthopedics and Traumatology, School of Medicine, Universidade Federal de Goiás, Goiânia, GO, Brazil.
Anatomopathology Service, School of Medicine, Universidade Federal de Goiás, Goiânia, GO, Brazil.
Rev Bras Ortop. 2014 Apr 24;49(4):401-4. doi: 10.1016/j.rboe.2014.04.010. eCollection 2014 Jul-Aug.
The aim of this study was to report on a rare case of Garré's sclerosing osteomyelitis. The patient was a 54-year-old woman with a history of treatment for lupus using corticoids for 20 years, and for osteoporosis using alendronate for five years. She presented edema and developed a limitation of left knee movement one year earlier, with mild effusion and pain on metaphyseal palpation, but without fever. She was in a good general state, without local secretion. Images of her knee showed trabecular osteolysis of the distal metaphysis of the femur and a periosteal reaction in both proximal tibias and both distal femurs, compatible with chronic osteomyelitis of low virulence and slow progression. Magnetic resonance imaging showed T2 hypersignal in the femur and tibia. Curettage was performed on the left distal femur, with release of secretion, but this was negative on culturing. A biopsy showed chronic infection and inflammation, fibrosis, xanthogranulomatous reaction and foci of suppuration. Antibiotic therapy was administered for six months. The etiology was not clarified: bacterial infection was suspected, but culturing was generally negative. The chronic process was maintained by low-virulence infection or even after treatment. The differential diagnoses were fibrous dysplasia, syphilis, pustulosis palmoplantaris, rectocolitis, Crohn's disease, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) and Paget's disease. The unifocal diseases were osteoid osteoma, Ewing's disease, osteosarcoma and eosinophilic granuloma.
本研究旨在报告一例罕见的加雷氏硬化性骨髓炎病例。患者为一名54岁女性，有使用皮质类固醇治疗狼疮20年及使用阿仑膦酸盐治疗骨质疏松症5年的病史。她一年前出现水肿，并出现左膝关节活动受限，干骺端触诊时有轻度积液和疼痛，但无发热。她一般状况良好，无局部分泌物。其膝关节影像显示股骨远端干骺端小梁骨溶解，双侧胫骨近端和双侧股骨远端有骨膜反应，符合低毒力、进展缓慢的慢性骨髓炎。磁共振成像显示股骨和胫骨T2高信号。对左股骨远端进行了刮除术，有分泌物排出，但培养结果为阴性。活检显示慢性感染和炎症、纤维化、黄色肉芽肿反应及化脓灶。给予抗生素治疗6个月。病因未明确：怀疑为细菌感染，但培养结果通常为阴性。慢性病程由低毒力感染维持，甚至在治疗后仍存在。鉴别诊断包括骨纤维发育不良、梅毒、掌跖脓疱病、直肠结肠炎、克罗恩病、滑膜炎、痤疮、脓疱病、骨肥厚和骨炎综合征（SAPHO）及佩吉特病。单病灶疾病包括骨样骨瘤、尤因肉瘤、骨肉瘤和嗜酸性肉芽肿。
