Neuritis ossificans mimicking a malignancy in a child: case report and literature review

Abstract

We present the case of a child with neuritis ossificans after acute trauma, treated conservatively. The aim of the review is to compare several parameters in this disease. Emphasis is placed on the clinical-radiological features distinguishing neuritis ossificans from malignancy to avoid unnecessary biopsy and surgery.A literature review was performed. Only 18 cases were described. Except for one, all describe adults, and none had acute trauma. Nearly all were treated surgically.Our 13-year-old patient presented with posterior knee pain after trauma. MRI demonstrated a mass within the tibial nerve with oedema, some lymph nodes and increased avidity on 18fluoro-2-deoxyglucose-positron emission tomography. These findings can be reactive but also associated with malignancy. However, eggshell-like calcifications in the periphery of the mass were seen on CT. Biopsy and resection were proposed. Follow-up visits over the next weeks showed remarkable clinical improvement. Wait-and-scan was advised after international discussion. Follow-up imaging after 2 months showed resolution of the oedema and volume reduction of the mass, suggesting a benign pathology. Diagnosis of neuritis ossificans was proposed based on the clinical and radiological features. There was a favorable course with no complaints after two months. Imaging after seven months showed an almost complete regression.Neuritis ossificans should be considered within a painfull (mono)neuropathy. The initial inflammatory phase may mimic malignancy, misleading clinicians toward biopsy or surgery with the risk of nerve damage. As seen in our case, neuritis ossificans can be a self-limiting process. Therefore, conservative therapy should be considered with a wait-and-scan approach.