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Cleveland Clinic Journal of MedicineBrodie Abscess in an 87-year-old Man

A Case Study Highlights the Importance of Timely Diagnosis and Treatment in Preventing Complications

An 87-year-old man’s journey from a misdiagnosis of a bone tumor to a late-stage Brodie abscess underscores the critical need for healthcare professionals to be vigilant in diagnosing and treating this rare form of osteomyelitis, particularly in older adults.

HCN Medical Memo
This case serves as a warning about the dangers of postponing Brodie abscess diagnosis and treatment, particularly in elderly individuals. It is essential to act quickly to avoid problems including bone grafting, amputation, and extended hospital stays. Given the sneaky nature of this illness, successful care requires a high index of suspicion and the right diagnostic procedures.

Key Points
  • An 87-year-old man initially presented with dull pain below his right knee and was misdiagnosed with a bone tumor.
  • One year later, the patient was admitted to the hospital with elevated inflammatory markers and a sinus tract connecting the tibial lesion to subcutaneous tissue.
  • Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the abscess, confirming a case of Brodie abscess.
  • The patient underwent surgical debridement and a 4-week course of intravenous vancomycin, followed by a 3-month course of oral minocycline.

Brodie abscess was first described in 1832 by Sir Benjamin Collins Brodie, making it one of the earliest recognized forms of osteomyelitis.

Additional Points
  • Brodie abscess is a rare form of subacute or chronic osteomyelitis, most commonly affecting the tibia.
  • The standard treatment involves surgical debridement and systemic antibiotic therapy.
  • Delay in treatment can lead to complications like sinus tracts, fistulas, or bone fractures.
  • Relapse rates are approximately 15% for Brodie abscess and 20% for chronic osteomyelitis.

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