[Value of whole-body MRI in vertebral fractures]

Area of Science:

• Pediatric Rheumatology
• Autoinflammatory Diseases
• Pediatric Orthopedics

Background:

• Chronic recurrent multifocal osteomyelitis (CRMO) is a rare pediatric autoinflammatory bone disorder.
• Vertebral fractures can be an initial, yet overlooked, manifestation of CRMO.
• Early diagnosis is crucial for effective management and preventing long-term complications.

Observation:

• A 14-year-old boy presented with acute dorsal pain, later diagnosed as vertebral fractures at T5 and T6.
• Initial imaging (radiographs, MRI) suggested fractures but differential diagnoses included malignancy and CRMO.
• Whole-body MRI (wbMRI) revealed multifocal, subclinical bone lesions characteristic of CRMO in the pelvis and tibiae.

Findings:

• The case highlights vertebral fracture as a potential presenting symptom of CRMO in pediatric patients.
• wbMRI proved instrumental in identifying widespread CRMO involvement, supporting the diagnosis.
• The findings underscore the utility of wbMRI in diagnosing CRMO, often obviating the need for bone biopsy.

Implications:

• CRMO should be considered in the differential diagnosis of pediatric vertebral fractures.
• wbMRI is a valuable, non-invasive tool for comprehensive CRMO assessment and diagnosis.
• This approach can lead to earlier diagnosis and treatment initiation for CRMO patients.