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Chronic Recurrent Multifocal Osteomyelitis: A Case Report with Atypical Presentation.

Miguel Pádua Figueiredo¹, Marco Pato¹, Fernando Amaral¹

¹Department of Orthopaedics, Hospital Prof. Doutor Fernando Fonseca, Estrada IC19, 2720-276 Amadora, Portugal.

Journal of Orthopaedic Case Reports

|June 21, 2017

Summary

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disease. This case highlights a unifocal presentation, emphasizing the need for early diagnosis to avoid misdiagnosis and ineffective treatments.

Keywords:

Nonbacterial chronic recurrent osteomyelitis

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Area of Science:

Pediatric Rheumatology
Pediatric Orthopedics
Pediatric Radiology

Background:

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disorder characterized by sterile osteomyelitis, often affecting multiple long bone metaphyses.
The etiology, prognosis, and optimal treatment for CRMO remain poorly understood and debated.
This report details a rare case of CRMO presenting as a unifocal lesion in an atypical location.

Observation:

A 12-year-old girl presented with a 3-month history of progressive left thigh pain.
Radiography revealed a permeative diaphyseal lesion of the left femur with significant periosteal reaction, initially raising concerns for malignancy or infection.
Biopsies confirmed chronic inflammation without neoplastic or infectious agents.

Findings:

The patient received a 6-month course of nonsteroid anti-inflammatories, corticosteroids, and bisphosphonates, showing significant clinical and radiological improvement.
No antibiotics were administered, and the patient remained stable at 18-month follow-up.
This case underscores the diagnostic challenges posed by CRMO's variable presentations, including unifocal lesions and unusual locations.

Implications:

High clinical suspicion is crucial for diagnosing CRMO to prevent unnecessary invasive procedures and prolonged antibiotic therapies.
The findings support considering 'nonbacterial osteomyelitis' as a more inclusive term for conditions like CRMO.
This case contributes to the understanding of CRMO's diverse clinical spectrum and aids in refining diagnostic and therapeutic approaches.