Chronic Recurrent Multifocal Osteomyelitis – A Case Report
Volume 8 | Issue 3 | September-December 2022 | Page: 22-26| Ebin Rahman, Subin Sugath, Unnikrishnan R, Joe Thomas
DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.146
Authors: Ebin Rahman [1] DNB Ortho, Subin Sugath [1] DNB Ortho, Unnikrishnan R [2] MD Radiology, Joe Thomas [3] MD Med. DNB Rheumatology
[1] Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Radiology, Aster Medcity, Kochi, Kerala, India.
[3] Department Of Rheumatology, Aster Medcity, Kochi, Kerala, India.
Address of Correspondence
Dr Ebin Rahman,
Senior Specialist, Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
E-mail: rahmanebin@gmail.com
Abstract
Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic auto-inflammatory bone disease of unknown aetiology that typically affects children and adolescents. It presents as recurrent episodes of bone pain and fever, resembling bacterial osteomyelitis, but cultures from lesions are sterile. It is unresponsive to antibiotic therapy. CRMO is a diagnosis of exclusion since no single clinical feature is pathognomonic. Radiological tests are often required and a bone biopsy may be needed in unclear cases.
Case Report: We report a case of an 8-year-old girl, with pain over both ankles and upper chest; history and radiological evaluation suggested osteomyelitis, but no adequate response to antibiotic treatment was observed. A bone biopsy was done to rule out malignancy. Whole body imaging revealed multiple bony lesions; based on which a diagnosis of chronic recurrent multifocal osteomyelitis was made. Patient was started on specific anti-inflammatory treatment with resolution of symptoms.
Conclusion: Chronic recurrent multifocal osteomyelitis should be suspected in a child with recurrent, multiple bone pain, modest increase of inflammatory indices, and lytic or sclerotic bone lesion on radiographs. Typical locations are the metaphyses of long bones, pelvis, clavicle, vertebral column, sternum, but any bone can be involved. We want to increase the awareness of this entity and as a differential diagnosis of recurrent, multifocal bone pain in an adolescent, thereby avoiding unnecessary antibiotic administration and bone biopsies.
Keywords: Chronic recurrent multifocal osteomyelitis, Bone pain, Non-steroidal anti-inflammatory drugs
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| How to Cite this Article: Rahman E, Sugath S, Unnikrishnan R, Thoma J | Chronic Recurrent Multifocal Osteomyelitis – A Case Report | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 22-26 | https://doi.org/10.13107/ijpo.2022.v08.i03.146 |
