Xanthogranulomatous osteomyelitis

Xanthogranulomatous osteomyelitis is a peculiar aspect of osteomyelitis characterized by prevalent histiocytic infiltrate and foamy macrophage clustering.[1]

Xanthogranulomatous osteomyelitis
Other namesXO
SpecialtyInfectious disease, orthopedic

Pathology
See also: Xanthogranulomatous inflammation

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] A neoplastic process can be suspected.

Management

Antibiotics has been used with success for cases with positive cultures, Curettage, bone grafting, and resection has been described in few studies[7].[8].[9]

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References
  1. Rosai J(2004). Rosai and Ackerman's Surgical Pathology. Philadelphia, Mosby, p. 2142.
  2. Cozzutto C (1984) Xanthogranulomatous osteomyelitis. Arch Pathol Lab Med 108:973-976.
  3. Vankalakunti M, Saikia UN, Mathew M, Kang M (2007). Xanthogranulomatous osteomyelitis of ulna mimicking a neoplasm. World J Surg Oncol 5(46):1-4.
  4. Kashani MM, Zakerian BZ, Shayan K, Riyasi F (2010). Xanthogranulomatous osteomyelitis of femur. Iran J Orthop Surg 8(4):187-190.
  5. Kamat G, Gramapuroit V, Shettar C, Myageri A(2011). Xanthogranulomatous osteomyelitis presenting as swelling in right tibia. Case report. Case Rep Pathol, in press.
  6. Nakashiro S, Fujivara S, Harada S, Hisatsugu T, Watanabe T (1995). Xanthogranulomatous cholecystitis. Cell composition and possible pathogenetic role of cell-mediated immunity.Pathol Res Pract 183:395-482.
  7. Pathak S, Gautam R, Prince PC, Bagtharia P, Sharma A. A Rare Case Report on Xanthogranulomatous Osteomyelitis of Hip Mimicking Tuberculosis and Review of Literature. Cureus. 2019 Oct;11(10).
  8. Nalini G. Xanthogranulomatous osteomyelitis: a case report. Medicine Journal. 2014 Dec 16;1(6):45.
  9. Sapra R, Jain P, Gupta S, Kumar R. Multifocal bilateral xanthogranulomatous osteomyelitis. Indian J Orthop. 2015. Jul-Aug;49(4):482-484. doi: 10.4103/0019-5413.159682.
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