Osteomyelitis Differential Diagnoses

Updated: Mar 01, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Diagnostic Considerations

Crystal arthropathies (gout and pseudogout) presents in a similar manner to septic arthritis. The diagnosis can be made by polarized microscopic examination of monosodium urate crystals in gout or calcium pyrophosphate crystals in pseudogout. [16]  

In children, Ewing sarcoma is a common form of bone malignancy. It presents with clinical symptoms of fever, pain, malaise, and swelling, which are very similar to those of osteomyelitis. Invasion of the tumor into the periarticular space is uncommon but, if present, can radiographically mimic septic arthritis. [17]  

Septic arthritis generally presents with acute pain, swelling, warmth, and decreased range of motion in a single joint. Only 40-60% of patients will have a fever at presentation. Laboratory studies and synovial fluid analysis are helpful for diagnosis. [16]

In patients with sickle cell disease, it can be challenging to differentiate between a vaso-occlusive crisis and an infection such as osteomyelitis. An infectious etiology is less likely if more than one area of the body is affected. Osteomyelitis also tends to have clinical symptoms (eg, pain, swelling, and fever) developing over a longer time course than a vaso-occlusive crisis. [18]

Differential Diagnoses