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Mycobacterial epiphyseal osteomyelitis may lead to physeal damage
Compared with epiphyseal osteomyelitis caused by bacteria or unidentified pathogens, mycobacterial epiphyseal osteomyelitis led to physeal damage in pediatric patients, according to study results.
Researchers retrospectively reviewed the clinical findings from eight children with mycobacterial primary epiphyseal osteomyelitis, using radiographs and MRI scans to determine local spread of the abscess outside the epiphysis during the disease course. The researchers determined the presence of limited joint mobility or growth disturbance using data obtained from the latest follow-up evaluation and assessed physeal damage with the use of MRI scans.
Using multiplex polymerase chain reaction, the researchers identified Mycobacterium bovis bacilli Calmette-Guérin in four patients, M. tuberculosis in three patients and non-tuberculous mycobacterium in one patient. Lesions were discovered at the distal femoral epiphysis in six patients, at the proximal tibial epiphysis in one patient and at the proximal humeral epiphysis in one patient, according to the researchers.
Although abscess was confined to the epiphysis at the time of initial presentation, study results showed it extended outside the epiphysis over time in seven cases. Additionally, MRI diagnosed lesions in the cartilaginous epiphysis in two patients.
Despite surgical drainage and medication, seven patients worsened and five required additional surgery, according to the researchers. Overall, focal physeal damage was found in five patients, and clinical growth disturbance in one patient.
The researchers concluded that MRI can be useful in the early diagnosis of a cartilaginous lesion, as well as in the evaluation of abscess spread and physeal damage.
Disclosure: The authors have no relevant financial disclosures.