Goutham Talluri, MD
Dr.
North central Bronx hospital, United States
Disclosure information not submitted.
Kamran Khan, MD
Dr.
Icahn School of Medical School at Mount Sinai, United States
Disclosure information not submitted.
Title: Rare Case of Sclerosing Osteomyelitis of Garre in the Rib
Introduction: Primary Chronic Sclerosing Osteomyelitis was first described by Carl Garre in 1893 with thickening of cortices and loss of medullary canal, without any features of Osteomyelitis. Garre’s sclerosing Osteomyelitis (GSO) is a rare condition which usually affects children and young adults (men under 30) presenting with localized pain around the bone (normally seen in the mandible) characterized by local thickening of the periosteum.
Case: 58 year male with history of Hypertension, Diabetes was admitted with chronic left chest pain, Also gives history of similar episodes in the past. First had this pain when he was 54, but this was the first time he was admitted to the hospital for Ischemic workup as he was uninsured. No childhood history of such pain was noted. No pertinent findings on the exam, no tender points. Laboratory testing was normal (troponin, CPK, liver function tests, vit D, ESR, CRP). X-Ray and CT of the chest confirmed GSO in the 6th left rib posteriorly. Patient’s pain improved with pain medication but was still persistent at the time of discharge. Patient had this pain on and off for a while and was seen in the emergency department again. This time he was given an orthopedics referral, biopsy showed chronic inflammation and patient later underwent a rib resection. Post-operatively, histology confirmed no malignancies. Patient was followed for a year and hasn’t had any more pain episodes.
Discussion: Although there are no definite diagnostic criteria, GSO is usually confirmed based on a prolonged follow up of more than 3 months with no evidence of growth on biopsy. There are rare instances where a trial of antibiotics is given which can be helpful and also post-operative broad-spectrum antibiotics are open for discussion. GSO involves long bones where Intramedullary reaming is shown to help but in thin bones resection seems to the choice. Anyway, before making the diagnosis of GSO, more serious conditions like Ewing’s sarcoma, osteosarcoma should be ruled out. Our case was unique in the sense that it was in an elderly gentleman with no prior history of a pain syndrome coming with complaints of chest pain which can be easily missed given a history of chronic co-morbidities. Also, GSO affecting the rib is a rare association.