Ewing’s Sarcoma of the Pubis in a Child Misdiagnosed as Osteomyelitis: A Case Report
A 9 year old girl with a bone lesion of the left pubis is presented. The clinical symptoms and signs were slowly progressive for almost a year and became more pronounced during the last two months. She was admitted with a painful swelling of the left groin, low-grade evening fever, an antalgic gait and increased inflammatory markers. Radiographic changes included mottled and motheaten medulla of the left pubic bone associated with ‘onion skinning’ periosteal reaction. The lesion was originally misinterpreted by clinical, laboratory and radiographic findings as osteomyelitis. The patient was treated with antibiotics and immobilization. The clinical findings were significantly improved after a month and even the radiographic examination showed a diminished extent of the medullary lesions. The patient was admitted again 2 months after the initial admission with a severe deterioration of the clinical symptoms. They included severe pain, moderate fever and a painful soft tissue mass with local signs of inflammation and inguinal lymph nodes. Histology from the mass indicated necrotic tissue, while an inguinal lymph node biopsy indicated neoplasia. A new bone biopsy indicated Ewing's sarcoma of the left pubis. The natural behavior of Ewing's sarcoma in the presented case demonstrated that it did not appear as an overwhelmingly aggressive tumor. The differential diagnosis from chronic osteomyelitis was further complicated by the marked remission of the clinical symptoms and signs and even the improvement of the radiographic findings following the antibiotic therapy
NK Sferopoulos
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