Osteochondroma after acute skeletal infection: a primary or a secondary lesion?

Secondary or acquired osteochondroma may develop following radiation exposure, trauma or surgery, and osteomyelitis. This report presents a 15-year-old patient with an osteochondroma of the anterolateral left distal tibial metaphysis, who received surgical treatment for an acute suppurative arthritis of the left ankle joint at the age of 4 years. The purpose of this paper is to present the challenging diagnostic enigma of the osteochondroma's etiology in our patient between a primary versus a secondary lesion. After analysing retrospectively the available information in the patient's files, we concluded that the osteochondroma was likely a primary lesion with modified presentation due to infection.