Related Experiment Video
Updated: Oct 8, 2025
A Metadata Extraction Approach for Clinical Case Reports to Enable Advanced Understanding of Biomedical Concepts
Published on: September 20, 2018
Clinical characteristics and outcomes of chronic nonbacterial osteomyelitis in children: a multicenter case series
Le Ma1, Haimei Liu2, Hanyun Tang3
1Department of Rheumatology and Immunology, Children's Hospital of Nanjing Medical University, Nanjing, China.
Insights
This study details the characteristics and treatments of pediatric Chronic nonbacterial osteomyelitis (CNO) in South China. Early diagnosis and increased awareness are crucial for better outcomes in children with CNO.
Area of Science:
- Pediatric Rheumatology
- Pediatric Orthopedics
- Pediatric Infectious Diseases
Background:
- Chronic nonbacterial osteomyelitis (CNO) is a rare inflammatory bone disorder in children.
- Accurate diagnosis and effective treatment strategies for CNO remain challenging.
Purpose of the Study:
- To comprehensively evaluate the demographic, clinical, laboratory, imaging, and histopathology features of pediatric CNO.
- To analyze treatment responses and outcomes in children diagnosed with CNO.
Main Methods:
- Retrospective multi-center case series.
- Involved pediatric patients diagnosed with CNO treated at five tertiary centers in South China.
- Data collected included patient characteristics, clinical presentation, diagnostic findings, and treatment regimens.
Main Results:
- 18 pediatric CNO cases were identified between 2014-2020.
- Common symptoms included bone pain and fever, with frequent involvement of tibiofibula and femur.
- MRI showed bone edema and marrow hyperintensity; biopsies confirmed chronic osteomyelitis without infection.
- NSAIDs were first-line treatment, with steroids, methotrexate, and biologics used for refractory cases.
Conclusions:
- This study provides valuable insights into the clinical spectrum of CNO in South China.
- Highlights the importance of recognizing CNO to reduce diagnostic delays and improve patient management.
- Emphasizes the need for increased awareness to minimize complications and optimize treatment strategies.
Objective:
The aim of this study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of children with Chronic nonbacterial osteomyelitis (CNO).
Methods:
Retrospective multi-center case series study of pediatric patients diagnosed with CNO treated at five tertiary centers in south China.
Results:
Totally there were 18 patients diagnosed as CNO between 2014 and 2020. The median age of onset was 9.2 years (range 3.7-13.1) and 55.6% were female. Median delay in diagnosis was 10.9 months (range 1.0-72.0). The most frequent presenting symptoms were bone pain (100%) and fever (44.4%). Most patients had more than one lesion (median of 5, range 1-7). Most frequently affected bones were tibiofibula (88.9%) and femur (77.8%). The MRI characteristics mainly presented as bone edema and hyperintensity in bone marrow. Bone biopsy was conducted in 11 patients (61.1%) with inflammatory cells infiltration manifested as chronic osteomyelitis, and none showed bacterial infection or tumor. In treatment, non-steroid anti-inflamatory drugs (NSAIDs) is used as the first-line drug followed by steriods, methotexate (MTX), salazosulfadimidine (SASP), Bisphosphonates and TNF-α inhibitor. Two refractory cases received combination therapy with Bisphosphonates and TNF-α inhibitor, and achieved good therapeutic effect.
Conclusions:
The present study described a multicenter series of CNO from south China and highlighted the clinical features, laboratory tests, imaging characteristics and treatment outcomes. Increasing awareness of this disease is important to decrease time to diagnosis, improve access to treatment, and reduce complications.
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:24Chronic Kidney Disease II: Clinical Manifestations
01:27Acute Pyelonephritis I: Introduction
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:30Pneumonia III: Complications and Assessment
01:29Acute Kidney Injury III: Clinical Manifestations