Chronic recurrent multifocal osteomyelitis in a pediatric patient, a case report

Abstract

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a very rare disease, of unknown origin that affects primarily the metaphysis of long bones. It is characterized by an insidious onset of symptoms and multiple remissions. The chronicity of symptoms, the diagnostic imaging and the lack of response to first line antibiotic treatment, should  be helpful for diagnostic.

Objective:  Present  a  clinical case,  based on clinical,  laboratory,  radiologic  imaging  and histopathological results, that ultimately led to the diagnostic  of CRMO.

Case  Report: A 9 year old,  female  patient,  with  one  month  of  bilateral  knee  and  left ankle arthralgia.  Bone  Gammagraphy  and  full  body  MRI,  showed  multifocal  bone inflammation. These findings led to a biopsy, that turned negative for malignancy and infection. Given all the information available from the laboratory test results, radiologic imaging and histopathological findings, CRMO diagnosis was made. NSAID treatment was order, with good results.

Conclusions:   CRMO  is  a  rare  disease  that  even  to  date  and  with  cutting  edge technology, still represents a diagnostic challenge that primarily relies on a  high level of suspicion, for a timely and correct treatment.