Bone & joints


Osteomyelitis overview

Last author update: 1 June 2012
Last staff update: 19 January 2022

Copyright: 2003-2023,, Inc.

PubMed Search: Osteomyelitis bone[title]

Dariusz Borys, M.D.
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Cite this page: Borys D. Osteomyelitis overview. website. Accessed March 23rd, 2023.
Definition / general
  • Infection of bone (osteitis) or bone marrow space (myelitis) = osteomyelitis
  • Usually pyogenic, fungal or tubercular
  • HIV+ patients may be infected by unusual organisms (eg. Mycobacterium avium)
  • Radiographically may resemble a neoplasm, particularly after antibiotic treatment
  • Severe osteomyelitis is not associated with grade IV sacral decubitus ulcers in non-septic patients; imaging may be misleading (Arch Pathol Lab Med 2003;127:1599)
  • May cause secondary AA amyloidosis
Clinical images
  • Caused by Treponema pallidum and T. pertenue (yaws)
  • Bone involvement more common in congenital syphilis (Int J STD AIDS 1992;3:161); appears at 5th month of gestation in areas of active endochondral ossification (osteochondritis) and periosteum
  • Acquired syphilis involves bone in tertiary phase, usually nose, palate, skull, tibia, vertebrae, hands / feet
Case reports
Radiology description
  • Permeative, destructive lesion with periosteal new bone formation
  • Chronic osteomyelitis: may produce focal destruction or focal abscess
  • Syphilis: reactive periosteal bone deposition (“saber shin” of tibia)
Radiology images

Contributed by Mark R. Wick, M.D.
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Metatarsal Xray

Gross description
  • Syphilis: bone destruction and production; necrotic, well defined bone defects of cortex and periosteum surrounded by sclerotic bone
Microscopic (histologic) description
  • Syphilis: edematous granulation tissue, plasma cells, granulomas, necrotic bone and new bone production
  • Xanthogranulomatous osteomyelitis: prominent foam macrophages arranged in a mosaic pattern with neutrophil infiltration, foam cell formation, numerous plasma cells, fibrin precipitates
Microscopic (histologic) images

Contributed by Mark R. Wick, M.D.
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Acute type

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Mandible with splendore phenomenon

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