Early Complete Remission of Osteoid Osteoma with Conservative Medical Management
A previously healthy 10-year-old boy visited a nearby hospital because of increasing pain and swelling in the area of his left leg that was first experienced a month ago. He had no history of previous trauma to the area of concern. His condition was diagnosed as osteomyelitis of the tibia and antibiotics were administrated. The patient showed no response to initial treatment for 2 months and was subsequently referred to our hospital. At his first visit to our hospital, he complained of severe nocturnal pain. Physical examination revealed mild swelling with tenderness in the middle part of his leg. Results of laboratory examinations indicated a normal white blood cell count, C-reactive protein level, and erythrocyte sedimentation rate. Radiographs showed a lucent zone and a surrounding sclerotic zone in the middle third of the tibia (). Computed tomography (CT) revealed a 10-mm circumscribed osteolytic area in the cortex of the tibia with surrounding sclerosis (). This radiographic appearance of a radiolucent nidus with surrounding sclerosis was consistent with the typical appearance of an osteoid osteoma. Moreover, a bone scan revealed the double-density sign, which is quite specific for diagnosis of osteoid osteoma (). Magnetic resonance (MR) images showed a 10-mm circumscribed abnormality located in the cortex of the tibia with surrounding soft tissue edema. The circumscribed signal abnormality was isointense in comparison with bone marrow on fat-suppressed T1-weighted images and was moderately enhanced by gadolinium (, ). Axial CT images of the lesion clearly demonstrated an osteolytic lesion corresponding to the abnormality seen on MR images. The patient’s symptoms markedly improved with NSAIDs and his parents did not provide consent for surgical treatment. He was therefore treated with a usual dose of ibuprofen (300 mg/day, 3 times daily) for 3 weeks. Within 3 weeks, his symptoms were almost completely resolved; he no longer needed NSAIDs and returned to normal life. Serial images including radiographs, CT scans and MR images revealed complete radiological resolution of the nidus 2.5 years after initial presentation (). An early complete remission of osteoid osteoma with conservative medical treatment was confirmed in this patient.\nAt the 5-year follow-up visit, patient was free of pain and there was no evidence of recurrence.