Radiographic changes of chronic recurrent multifocal osteomyelitis that persisted into adulthood.

Area of Science:

• Pediatric Rheumatology
• Autoinflammatory Diseases
• Osteomyelitis

Background:

• Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, non-infectious autoinflammatory disorder.
• CRMO predominantly affects young females, making its presentation in males less common.

Observation:

• A 13-year-old male presented with multifocal bone pain (tibia, humerus, clavicle, hip).
• Clinical and radiographic progression over 10 years showed sclerotic changes evolving into osteolytic lesions.
• Bone biopsy excluded infection and neoplasia, but inflammatory markers (ESR, CRP) were elevated.

Findings:

• The patient was diagnosed with CRMO, despite initial suspicion of chronic bacterial osteomyelitis.
• Antibiotic treatment was initiated due to overlapping clinical and laboratory findings.
• Diagnostic delays can occur when CRMO mimics chronic bacterial osteomyelitis.

Implications:

• This case underscores the importance of considering CRMO in young males presenting with chronic bone pain and inflammatory markers.
• Distinguishing CRMO from chronic bacterial osteomyelitis requires a high index of suspicion and comprehensive diagnostic evaluation.
• Accurate diagnosis of CRMO is essential to guide appropriate anti-inflammatory therapy and avoid unnecessary antibiotic use.