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Chronic recurrent multifocal osteomyelitis. Association with vertebra plana
1Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts 02115.
The Journal of Bone and Joint Surgery. American Volume
|January 1, 1989
Summary
Chronic recurrent multifocal osteomyelitis in children often shows negative cultures despite typical bone infection signs. These lesions typically resolve spontaneously over time without antibiotic treatment.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
- Pediatric Infectious Diseases
Background:
- Chronic recurrent multifocal osteomyelitis (CRMO) presents diagnostic challenges.
- CRMO shares radiographic and histological features with infectious osteomyelitis.
- Distinguishing CRMO from infectious osteomyelitis is crucial for appropriate management.
Purpose of the Study:
- To analyze clinical, radiographic, histological, and microbiological findings in pediatric CRMO.
- To characterize the natural history and diagnostic criteria for CRMO.
- To inform decisions regarding antibiotic therapy withholding.
Main Methods:
- Retrospective review of seven children with CRMO.
- Analysis of thirty-nine osseous lesions across multiple sites.
- Detailed examination of clinical, radiographic, histological, and microbiological data.
Main Results:
- Radiographic and histological findings mimicked osteomyelitis, but cultures were consistently negative.
- Lesions most commonly affected the spine, tibia, and femur.
- Three patients exhibited vertebra plana, and spontaneous resolution was observed.
Conclusions:
- CRMO is a diagnosis of exclusion, requiring negative cultures.
- Biopsy is recommended for definitive diagnosis.
- Spontaneous resolution suggests conservative management may be appropriate, withholding antibiotics.