Resumo Relatar um caso raro de osteomielite esclerosante de Garrè. Paciente feminino, 54 anos, com história de tratamento de lúpus com corticoide havia 20 anos e osteoporose, em uso de alendronato havia cinco anos. Apresentava edema e limita??o do joelho esquerdo havia um ano, derrame leve, dor à palpa??o metafisária, afebril, bom estado geral, sem secre??o local. Imagens do joelho evidenciaram osteólise trabecular da metáfise distal do fêmur e rea??o periosteal nas duas tíbias proximais e nos dois fêmures distais, compatíveis com osteomielite cr?nica, de baixa virulência e progress?o lenta. Hipersinal em {T2} no fêmur e tíbia à ressonancia. Curetagem do fêmur distal esquerdo, com saída de secre??o, mas cultura negativa. Biópsia evidenciou infec??o e inflama??o cr?nica, fibrose, rea??o xantogranulomatosa e focos de supura??o. Feita antibioticoterapia por seis meses. Etiologia n?o esclarecida, suspeita de infec??o bacteriana, mas geralmente a cultura é negativa, processo cr?nico mantido por infec??o de baixa virulência ou mesmo após o tratamento. Diagnósticos diferenciais: displasia fibrosa, sífilis, pustulose palmoplantar, retocolite, Crohn, Sapho (sinovite, acne, pustulose, hiperostose, osteíte) e Paget. Unifocais: osteoma osteoide, Ewing, osteossarcoma e granuloma eosinofílico. Abstract The aim was to report on a rare case of Garré’s sclerosing osteomyelitis. The patient was a 54‐year‐old woman with a history of treatment for lupus using corticoids for 20 years, and for osteoporosis using alendronate for five years. She presented edema and developed a limitation of left knee movement one year earlier, with mild effusion and pain on metaphyseal palpation, but without fever. She was in a good general state, without local secretion. Images of her knee showed trabecular osteolysis of the distal metaphysis of the femur and a periosteal reaction in both proximal tibias and both distal femurs, compatible with chronic osteomyelitis of low virulence and slow progression. Magnetic resonance imaging showed {T2} hypersignal in the femur and tibia. Curettage was performed on the left distal femur, with release of secretion, but this was negative on culturing. A biopsy showed chronic infection and inflammation, fibrosis, xanthogranulomatous reaction and foci of suppuration. Antibiotic therapy was administered for six months. The etiology was not clarified: bacterial infection was suspected, but culturing was generally negative. The chronic process was maintained by low‐virulence infection or even after treatment. The differential diagnoses were fibrous dysplasia, syphilis, pustulosis palmoplantaris, rectocolitis, Crohn's disease, {SAPHO} (synovitis, acne, pustulosis, hyperostosis and osteitis) and Paget's disease. The unifocal diseases were osteoid osteoma, Ewing's disease, osteosarcoma and eosinophilic granuloma.
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