A possible case of Garre's sclerosing osteomyelitis from Medieval Tuscany (11th-12th centuries)

tArchaeological excavations carried out at the castle of Monte di Croce near Florence brought to light asmall cemetery complex belonging to the castle church, dated back to the 11th–12th centuries. An elitestone tomb contained the skeletal remains of a male aged 35–45 years with obvious pathology of theright tibia. The proximal metaphysis and the upper half of the diaphysis appear massively enlarged as aresult of severe chronic periostitis. A transverse section illustrates complete obliteration of the medullarycavity by new spongy bone, with some large cavitations. The primary, but completely remodeled tibialshaft is still recognizable. This finding and the strong sclerotic reaction with some central cavitationsrule out any form of bone tumor and indicate a chronic inflammatory disease. The morphological andradiological picture and the tibial localization suggest a diagnosis of chronic sclerosing osteomyelitis ofGarré, a rare form of chronic osteomyelitis characterized by an intense periosteal reaction with little orno suppuration.