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[Mandibular involvement in chronic recurrent multifocal osteomyelitis (CRMO) in adulthood]
S Weihe1, H Eufinger, O Terhaar
1Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische Operationen, Ruhr-Universität Bochum. stephan.weihe@ruhr-uni-bochum.de
Mund-, Kiefer- Und Gesichtschirurgie : MKG
|July 20, 2000
Summary
Chronic recurrent multifocal osteomyelitis (CRMO) may cause therapy-resistant mandibular osteomyelitis. Early diagnosis with bone scans is crucial for appropriate immunosuppressive treatment, differing from bacterial infections.
Area of Science:
- Oral and Maxillofacial Surgery
- Rheumatology
- Pediatric Rheumatology
Background:
- Chronic osteomyelitis of the mandible is challenging, especially when resistant to antibiotics and lacking microbial growth.
- This case highlights a diagnostic dilemma in therapy-resistant osteomyelitis.
Observation:
- A 42-year-old patient presented with refractory mandibular osteomyelitis, initially unresponsive to antibiotics.
- Imaging revealed extensive sclerotic and osteolytic changes in the mandible, with unexpected lesions in the rib, sternum, and spine.
- Histopathology was consistent with chronic osteomyelitis but did not identify a specific pathogen.
Findings:
- A 3-phase skeletal scan and MRI confirmed multifocal bone involvement, leading to a diagnosis of chronic recurrent multifocal osteomyelitis (CRMO).
- Immunosuppressive therapy with diclofenac and prednisolone induced complete remission.
Implications:
- CRMO should be considered in cases of primary, therapy-resistant osteomyelitis, particularly when bacterial causes are excluded.
- Early diagnosis via bone scintigraphy is vital as CRMO treatment differs significantly from bacterial osteomyelitis.
- This case underscores the importance of considering non-bacterial causes for refractory osteomyelitis in the mandible.