Subacute osteomyelitis of the tibial diaphysis associated with Brodie's abscess: A rare case report of a four-year-old child

INTRODUCTION: Septic osteomyelitis is a hematogenous bacterial bone infection. The acute presentation is the most common; the subacute one is less frequent. The aim of our case report is to put forward the features of this uncommon presentation and to propose a therapeutic management. PRESENTATION OF CASE: We report a rare case of subacute osteomyelitis associated with Brodie's abscess of the tibial diaphysis in a four-year-old child. The chief complaint was a pain in the left tibia evolving for five weeks. The radiological findings and the unusual location of this pathology suggested a malignant bone tumor. Thanks to imaging assessment and bone biopsy the diagnosis of subacute osteomyelitis associated with Brodie's abscess was made. Therefore, the child had antibiotic therapy and plaster immobilization to avoid pathological fracture. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal. DISCUSSION: We report an uncommon case of subacute osteomyelitis which evolved to Brodie's abscess with diaphyseal location. The mainstream treatment is surgery combined with antibiotics. However, medical treatment alone can lead to recovery without sequelae. CONCLUSION: Because of the atypical location and presentation of subacute osteomyelitis, the other differential diagnoses, especially malignant bone tumors have to be eliminated. In some cases, treatment may be based on antibiotics therapy alone.