A Case of Sterile Osteomyelitis: Chronic Recurrent Multifocal Osteomyelitis (CRMO)

Chronic recurrent multifocal osteomyelitis (CRMO) is a rarely reported autoimmune inflammatory condition affecting children and young adults. The typical complaint is recurrent severe bone pain at multiple sites; often imaging suggests features of osteomyelitis or malignancy. However, the biopsy is always negative for any growth in culture and histopathology detects only inflammatory cells. This is a diagnosis of exclusion with various diagnostic criteria. We had a 20-year-old male presenting with recurring pain and swelling in the right hand and left foot for more than seven months. Imaging revealed bone marrow edema with the expansion of bone and sclerosis involving the third metacarpal of the right hand and first metatarsal of the left foot. Acute phase reactants were mildly raised with biopsy showing inflammatory cells. However, the cultures grown from the lesion were sterile. After comparing it with the various diagnostic criteria, a diagnosis of CRMO was made.