Medicine:Xanthogranulomatous osteomyelitis
| Xanthogranulomatous osteomyelitis | |
|---|---|
| Other names | XO |
| Specialty | Infectious disease, orthopedic |
Xanthogranulomatous osteomyelitis is a peculiar aspect of osteomyelitis characterized by prevalent histiocytic infiltrate and foamy macrophage clustering.[1]
Pathology
The granulomatous tissue largely comprises foam cells of monocyte/macrophage origin positive for KP1, HAM56, CD11b and CD68. Neutrophils, hemorrhagic foci and numerous plasma cells are additional findings.[2][3][4][5] Staphylococcus aureus was isolated in the case reported by Kamat et al.[5] A delayed type hypersensitivity reaction in cell-mediated immunity has been suggested in this type of infiltrate that is composed of macrophages and T cells.[3] T cells are represented by a mixture of CD4+ and CD8+ lymphocytes. Macrophages and lymphocytes show marked expression of HLA-DR antigen.[6] Arguably XO is the bone localization of the xanthogranulomatous process occurring in several other locations.[2]
Diagnosis
As of 2011 five cases had been reported, involving rib, tibial epiphysis, ulna, distal tibia and femur. Young individuals are prevalently affected but one case involved a 50-year-old woman. Pain, swelling of possibly long duration, fever and increased ESR are some of the main clinical findings. X-ray examination shows lytic foci with sclerotic margins.[2][3][4][5]
Management
Antibiotics have been used with success for cases with positive cultures, Curettage, bone grafting, and resection has been described in few studies.[7][8]
References
- ↑ Rosai and Ackerman's Surgical Pathology. Philadelphia: Mosby. 2004. p. 2142.
- ↑ 2.0 2.1 2.2 "Xanthogranulomatous osteomyelitis". Archives of Pathology & Laboratory Medicine 108 (12): 973–6. December 1984. PMID 6334505.
- ↑ 3.0 3.1 3.2 "Xanthogranulomatous osteomyelitis of ulna mimicking neoplasm". World Journal of Surgical Oncology 5: 46. April 2007. doi:10.1186/1477-7819-5-46. PMID 17470270.
- ↑ 4.0 4.1 "Xanthogranulomatous osteomyelitis of femur.". Iran J Orthop Surg 8 (4): 187–190. 2010. http://www.ijos.ir/article_121114_28f756598b4ed33293a62e68d31d75a0.pdf.
- ↑ 5.0 5.1 5.2 "Xanthogranulomatous osteomyelitis presenting as swelling in right tibia". Case Reports in Pathology 2011: 257458. 2011. doi:10.1155/2011/257458. PMID 22937381.
- ↑ "Xanthogranulomatous cholecystis. Cell composition and a possible pathogenetic role of cell-mediated immunity". Pathology, Research and Practice 191 (11): 1078–86. November 1995. doi:10.1016/S0344-0338(11)80651-5. PMID 8822108.
- ↑ "A Rare Case Report on Xanthogranulomatous Osteomyelitis of Hip Mimicking Tuberculosis and Review of Literature". Cureus 11 (10): e5921. October 2019. doi:10.7759/cureus.5921. PMID 31788379.
- ↑ "Multifocal bilateral xanthogranulomatous osteomyelitis". Indian Journal of Orthopaedics 49 (4): 482–4. 2015. doi:10.4103/0019-5413.159682. PMID 26229173.
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