Background: chronic osteomyelitis represents a persistent bone and bone marrow infection easy to diagnose in the presence of pain, erythema, swelling, and a draining sinus but more difficult to detect in the absence of the preceding features and with a painful orthopaedic prosthesis.
Case description: we report upon an elderly gentleman with myelodysplasia requiring revision surgery for a fractured prosthetic left knee. He had clinical, laboratory, and radiological features of chronic osteomyelitis that improved only with administration of granulocyte colony stimulating factor (G-CSF).
Literature review: G-CSF has been successfully employed to treat resistant osteomyelitis in three young patients with primary defects of monocyte and neutrophil killing. A randomized trial confirmed the efficacy of G-CSF in the treatment of chronic osteomyelitis in twenty patients with diabetic foot ulcers and a rat model confirmed the efficacy of G-CSF in acute osteomyelitis.
Clinical relevance: our case highlights the usefulness of G-CSF treatment for immune suppressed patients with resistant chronic osteomyelitis.