CHRONIC SCLEROSING OSTEOMYELITIS

Abstract

In 1893 Ganr#{233} described a sclerosing form of osteomyelitis that caused distension and thickening of bone, but no suppuration, sequestration or fistula formation. Hardmeier, Uehlingen and Muggli (1974) introduced the term primary chronic sclenosing osteomyelitis to differentiate the clinical presentation of chronic osteomyelitis from the clinical description given by Garr#{233} ; they also described the radiological appearances. Primary chronic sclerosing osteomyelitis is a rare condition often causing diagnostic difficulty (Cabanela et a!. 1974; Kopits and Debuskey 1977). Such is the insidious onset and the radiological appearances of expansion and sclerosis of bone (Jacobsson et a!. 1978), combined with the absence of signs of acute sepsis, that this condition often gives rise to a preliminary diagnosis of Ewing’s sarcoma, osteosancoma (Cabanela et al. 1974) or osteoid osteoma (Jaffe and Lichtenstein 1940). Positive bacteriological culture is uncommon (Anderson 1980 ; Collert and Isacson 1982) although there may be a history of chronic sepsis at another site (Tunlington 1973 ; Kopits and Debuskey 1977 ; Goldstein, Byrne and Miller 1979). The characteristic radiological appearance is one of reactive sclerosis with layers ofsubpeniosteal bone visible. Cystic change may occur within the sclerotic area, but sequestra are uncommon. Radioisotope bone scanning using technetium-99m shows a high uptake at four hours. (Jacobsson et a!. 1978).