Clinico-Radiologic Spectrum and Outcomes of Chronic Non-Infectious Osteomyelitis: Experience from India

To study the clinical characteristics, radiological features and outcome of children with chronic non-infectious osteomyelitis (CNO).

Children diagnosed with CNO (as per the Bristol diagnostic criteria) in between October 2016 to September 2024 were enrolled for this retrospective study. De-identified data from medical records were analysed to study clinico-radiological characteristics, treatment and outcomes.

Among 19 children (11 boys) with median (range) age of 11 y (5-13 y), 5 had clinically unifocal osseous disease, while 14 had multifocal involvement. 15 (79%) patients were initially treated as infectious osteomyelitis (bacterial: 9, tubercular: 6). Median (range) delay in diagnosis from symptom onset was 13.5 mo (3-72). Whole-body magnetic resonance imaging (WBMRI) revealed 85 additional lesions than those identified by clinical examination. Clavicle (n = 9) and tibia (n = 20) were most common sites in axial and appendicular skeleton, respectively. Of 66 lesions in long bones, epiphysis, metaphysis, and diaphysis were involved in 11 (16.6%), 28 (42.5%), and 27 (40.9%), respectively. 15 diaphyseal lesions (22.8%) had concomitant metaphyseal involvement (categorised as meta-diaphyseal), while 12 lesions (18.1%) were localised to diaphysis only. Seventeen children opted for treatment at the present centre. Two children were managed with NSAIDS alone, 15 received pamidronate, and one required pamidronate along with steroids and etanercept. Ten patients (66%) achieved clinical remission after the second course of pamidronate. Two children experienced vertebral collapse and one developed left foot valgus deformity.

More than half of the patients were treated as presumed infectious osteomyelitis before the definitive diagnosis of CNO. In the present series, 65.3% CNO lesions involved the metaphysis (42.5%) or meta-diaphysis (22.8%) of long bones. 18.1% lesions were restricted to diaphysis in isolation.