Cranial aseptic osteomyelitis associated with pyoderma gangrenosum

Area of Science:

• Dermatology
• Rheumatology
• Orthopedics

Background:

• Neutrophilic dermatoses are a diverse group of inflammatory skin conditions.
• These conditions can uncommonly involve other tissues with aseptic neutrophilic abscesses.
• Bone involvement is rare, typically seen in pediatric chronic recurrent multifocal osteomyelitis (CRMO).

Observation:

• A 34-year-old female presented with intractable headaches.
• Imaging revealed an osteolytic lesion in the parietal bone, diagnosed as osteomyelitis.
• Pyoderma gangrenosum developed on her legs one year later.

Findings:

• The patient's headache and skin lesions resolved with oral prednisone treatment.
• This case represents an exceptional instance of bone involvement in an adult with neutrophilic dermatoses.
• Only two adult cases of CRMO have been previously reported, one with a history of childhood CRMO and another contiguous to pyoderma gangrenosum.

Implications:

• This case expands the understanding of neutrophilic dermatoses presentations in adults.
• It underscores the importance of considering systemic involvement, including bone, in these conditions.
• The successful treatment with corticosteroids suggests a potential therapeutic approach for similar rare adult cases.