XANTHO-GRANULOMATOUS OSTEOMYELITIS OF STERNUM, RESEMBLING A TUMOR: FIRST REPORTED CASE

Abstract

Xantho-granulomatous inflammation is a rare type of chronic inflammation, when seen in the bones it is known as xanthogranulomatous osteomyelitis (XO). Here we present a rare case XO of the manubrium sterni, to best of our knowledge this is the first diagnosed. XO of the manubrium sterni mimics radiologically as tuberculosis and as eosinophillic granuloma. We have a 23 year old lady who presented with pain and swelling in the anterior chest, radiology was done and finally the lesion was biopsied. We accepted the patient as Xanthomatous Osteomyelitis and planned for into excision of manubrium sterni, with a flap comprising of ribs and muscle advancements to cover the midline gap in the chest wall, that would have been created. Meanwhile she was put on a short course of antibiotics. It had been observed that the first open biopsy scar had exhibited a tendency for keloid formation. Hence, the risk of final surgery incision producing a disfiguring keloid was informed to the patient, which unfortunately led the patient deter surgery indefinitely, since she was to be married soon. We proposed a local injection of steroid into the lesion to minimize the inflammation. Under image intensifier we injected 40 mg of methyl prednisolone into the tumor. There was some tolerable discomfort the next day of injection that eventually subsided in 3 days. However, the biopsy came inconclusive second core needle biopsy came as XO. Since 1984 with the first case by Cozzutto et al, only 17 cases have been reported in the worldwide literature including us.