Chronic nonbacterial osteomyelitis: a typical case and review.

Area of Science:

• Pediatric Rheumatology
• Autoinflammatory Diseases
• Bone Metabolism

Background:

• Chronic Non-bacterial Osteomyelitis (CNO) is a rare autoinflammatory bone disorder affecting children and adolescents.
• It presents with variable severity, from mild to severe multifocal bone inflammation.
• Unclear etiology and nonspecific symptoms complicate CNO diagnosis.

Purpose of the Study:

• To report a case of a 14-year-old girl diagnosed with Chronic Non-bacterial Osteomyelitis (CNO).
• To illustrate the diagnostic challenges and treatment progression for CNO.
• To highlight the efficacy of advanced therapies in refractory CNO cases.

Main Methods:

• A 14-year-old female presented with recurrent clavicle swelling and pain.
• Diagnosis involved extensive workup, including imaging and biopsies, excluding infection and malignancy.
• Initial treatment included NSAIDs and oral medications; escalated to bisphosphonates and biologics for refractory symptoms.

Main Results:

• The patient was diagnosed with CNO based on clinical and histopathological findings.
• Initial treatment provided temporary relief, but symptoms recurred.
• Escalation to intravenous pamidronate and subcutaneous adalimumab achieved sustained clinical remission over a two-year follow-up.

Conclusions:

• CNO diagnosis is often by exclusion, with MRI crucial for assessment.
• NSAIDs are first-line, but bisphosphonates and biologics are vital for refractory cases.
• This case emphasizes the need for multidisciplinary management and further research for standardized CNO treatment.