[A rare condition underlying childhood back pain: chronic nonbacterial osteomyelitis]

In addition to the more common benign conditions, spinal pain can also be caused by malignant lesions and severe inflammatory conditions. Besides detailed laboratory tests, imaging diagnostics are of paramount importance in the investigation. Bone pain is rarely associated with chronic nonbacterial osteomyelitis. The authors present the case of a 9-year-old girl who presented with progressive back pain of several months’ duration. Laboratory tests showed no pathological abnormalities other than mildly elevated inflammatory activity. The magnetic resonance (MR) scan showed compression localized on the 8th thoracic vertebra with a hyperintense, cumulative pattern along the lower endplate of the vertebral body. Biopsy sampling was performed to clarify the exact etiology. Histopathological examination excluded malignancy and showed abnormalities suggestive of chronic inflammation. The patient was treated temporarily with steroids, but relapsed and biological therapy, adalimumab was initiated. The therapy proved to be effective, with persistent remission observed both in clinical symptoms and in radiological findings. The present case report highlights a rare pathology underlying spinal pain. MR imaging is of diagnostic value in the diagnosis of this condition. Treatment of the disease requires the use of immunosuppressive therapy. Orv Hetil. 2024; 165(15): 595–600.