Challenges in the Diagnosis of Brodie’s Abscess in Subacute Osteomyelitis

INTRODUCTION: Subacute osteomyelitis (OM) is a difficult condition to diagnose and treat, further complicated with an atypical presentation of a Brodie’s abscess (BA). BA is typically seen in pediatric, male populations, with minimal incidence in adult populations. Concern for malignancy and cold abscess can preempt oncological work-up. Duration of symptoms and radiological findings are often helpful but may not always match known classical findings. CASE REPORT: Here we present a case of subacute OM in a 30-year-old Japanese male with a distant medical history of OM as a child with a subsequent review of Brodie’s versus cold abscesses in the context of an atypical, asymptomatic presentation. CONCLUSION: Clinical history and suspicion can be crucial to determine the presence of a BA in comparison to a cold abscess in the context of subacute OM. Crossing multiple disciplines from primary care and emergency treatment to orthopedic and oncological surgery, providers must be aware of atypical presentations of OM. Recurrence is unlikely with correct diagnosis and adequate surgical debridement and antibiotics, which, in turn, can improve patient outcomes and decrease unnecessary testing.