[Chronic recurrent multifocal osteomyelitis. A diagnosis to be called to mind]

Area of Science:

• Pediatric Rheumatology
• Orthopedic Surgery
• Dermatology

Background:

• Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disorder predominantly affecting children and adolescents.
• It typically manifests with insidious onset of localized swelling and pain in multiple metaphyses, often with a symmetric and recurrent pattern.
• CRMO can be associated with cutaneous conditions like palmoplantar pustulosis or acne fulminans, and less commonly with inflammatory bowel disease.

Purpose of the Study:

• To summarize the clinical characteristics, pathogenesis, diagnostic considerations, and management of chronic recurrent multifocal osteomyelitis.
• To highlight the importance of differentiating CRMO from infectious osteomyelitis and bone tumors.
• To provide an overview of the typical disease course and treatment efficacy.

Main Methods:

• Literature review of CRMO cases and established etiological theories.
• Analysis of clinical presentation, including typical and atypical manifestations.
• Discussion of diagnostic procedures, emphasizing biopsy and culture for differential diagnosis.

Main Results:

• CRMO is characterized by recurrent, multifocal bone lesions, primarily in metaphyses, with possible spinal involvement.
• Pathogenesis is often linked to enthesopathy, where enthesitis progresses to aseptic osteomyelitis.
• Biopsy with culture is crucial to exclude bacterial infection and malignancy, especially in solitary bone lesions.

Conclusions:

• CRMO follows a benign, self-limited course with recurrences and remissions over 6-10 years.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are generally effective for treatment.
• Prompt diagnosis and appropriate management are essential for favorable outcomes in pediatric patients with CRMO.