First of all,if the osteomyelitis is chronic in nature,then it presents with subtle symptoms and so diagnosis can be delayed. Chronic osteomyelitis may cause flare-ups of symptoms, such as pain and fever, many years after the initial infection.This is seen only when specific diagnostic tests are done.
Secondly, some times infections or inflammations of any of the organs of the body can cause osteomyelitis by infections spreading to bones and as the primary mode of treatment will be for the basic pathology,so osteomyelitis can be missed.Wiley interscience mentions one such case of prostatitis which caused destructive osteomyelitis and was diagnosed after thorough investigations due to subtleness and less aggressiveness of its symptoms.
Osteomyelitis can also be missed as a diagnosis if initial tests are done without confirmatory tests like CT/MRI or bone biopsy.
Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional queries.
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