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Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Osteomyelitis | Case report

A complicated path to the CRMO diagnosis – case of a 9 year old girl whose story comes full circle

Authors: Joanna Świdrowska-Jaros, Elżbieta Smolewska

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

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Abstract

Background

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic autoinflammatory bone disease that mostly affects children and adolescents. It is a diagnosis of exclusions since no clinical signs and symptoms are pathognomonic. Radiological tests are often essential, but bone biopsy may be needed in unclear cases.

Case presentation

A 9-year-old Caucasian girl with a history of bone pain. The data from the history and results of laboratory tests suggested osteomyelitis, but no adequate response to the treatment was observed. A number of imaging tests did not confirm the diagnosis, therefore a bone biopsy was necessary.

Conclusions

Differential diagnosis of CRMO is challenging and it is based on exclusions. Since it might be misdiagnosed or mistreated, bone biopsy should be considered in patients reporting bone pain who are unresponsive to treatment.
Literature
1.
go back to reference Fergusson PJ, Sandu M. Current understanding of the pathogenesis and Management of Chronic Recurrent Multifocal Osteomyelitis. Curr Rheumatol Rep. 2012;14:130–41.CrossRef Fergusson PJ, Sandu M. Current understanding of the pathogenesis and Management of Chronic Recurrent Multifocal Osteomyelitis. Curr Rheumatol Rep. 2012;14:130–41.CrossRef
2.
go back to reference Hedrich CM, Hofmann SR, Pablik J, et al. Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol. 2013;11:47.CrossRef Hedrich CM, Hofmann SR, Pablik J, et al. Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol. 2013;11:47.CrossRef
3.
go back to reference Acikgoz G, Averill LW. Chronic recurrent multifocal osteomyelitis: typical patterns of bone involvement in whole-body bone scintigraphy. Nucl Med Commun. 2014;35:797–807.PubMed Acikgoz G, Averill LW. Chronic recurrent multifocal osteomyelitis: typical patterns of bone involvement in whole-body bone scintigraphy. Nucl Med Commun. 2014;35:797–807.PubMed
4.
go back to reference Hofmann SR, Schnabel A, Rösen-Wolff A, et al. Chronic nonbacterial osteomyelitis: pathophysiological concepts and current treatment strategies. J Rheumatol. 2016;43:1956–64.CrossRefPubMed Hofmann SR, Schnabel A, Rösen-Wolff A, et al. Chronic nonbacterial osteomyelitis: pathophysiological concepts and current treatment strategies. J Rheumatol. 2016;43:1956–64.CrossRefPubMed
5.
go back to reference Hofmann SR, Kapplusch F, Girschick HJ, et al. Chronic recurrent multifocal osteomyelitis (CRMO): presentation, pathogenesis, and treatment. Curr Osteoporos Rep. 2017;15:542–54.CrossRefPubMedPubMedCentral Hofmann SR, Kapplusch F, Girschick HJ, et al. Chronic recurrent multifocal osteomyelitis (CRMO): presentation, pathogenesis, and treatment. Curr Osteoporos Rep. 2017;15:542–54.CrossRefPubMedPubMedCentral
6.
go back to reference Girschick HJ, Zimmer C, Klaus G, et al. Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol. 2007;3:733–8.CrossRefPubMed Girschick HJ, Zimmer C, Klaus G, et al. Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol. 2007;3:733–8.CrossRefPubMed
7.
go back to reference Oligbu G, Jacobs B, Khan T. The Dilemma of Chronic Recurrent Multifocal Osteomyelitis. Reumatol Clin. 2019;18:30235–3. Oligbu G, Jacobs B, Khan T. The Dilemma of Chronic Recurrent Multifocal Osteomyelitis. Reumatol Clin. 2019;18:30235–3.
8.
go back to reference Roderick MR, Shah R, Rogers V, et al. Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis. Pediatr Rheumatol Online J. 2016;14:47.CrossRefPubMedPubMedCentral Roderick MR, Shah R, Rogers V, et al. Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis. Pediatr Rheumatol Online J. 2016;14:47.CrossRefPubMedPubMedCentral
9.
go back to reference Manson D, Wilmot DM, King S, et al. Physeal involvement in chronic recurrent multifocal osteomyelitis. Pediatr Radiol. 1989;20(1–2):76–9.CrossRefPubMed Manson D, Wilmot DM, King S, et al. Physeal involvement in chronic recurrent multifocal osteomyelitis. Pediatr Radiol. 1989;20(1–2):76–9.CrossRefPubMed
10.
go back to reference Beretta-Piccoli BC, Sauvain MJ, Gal I, et al. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in childhood: a report of ten cases and review of the literature. Eur J Pediatr. 2000;159:594–601.CrossRefPubMed Beretta-Piccoli BC, Sauvain MJ, Gal I, et al. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in childhood: a report of ten cases and review of the literature. Eur J Pediatr. 2000;159:594–601.CrossRefPubMed
11.
12.
go back to reference Alshammari A, Usmani S, Elgazzar AH, et al. Chronic recurrent multifocal osteomyelitis in children: a multidisciplinary approach is needed to establish a diagnosis. World J Nucl Med. 2013;12:120–3.CrossRefPubMedPubMedCentral Alshammari A, Usmani S, Elgazzar AH, et al. Chronic recurrent multifocal osteomyelitis in children: a multidisciplinary approach is needed to establish a diagnosis. World J Nucl Med. 2013;12:120–3.CrossRefPubMedPubMedCentral
14.
go back to reference Khanna G, Sato TS, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics. 2009;29:1159–77.CrossRefPubMed Khanna G, Sato TS, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics. 2009;29:1159–77.CrossRefPubMed
15.
go back to reference Buck FM, Treumann FC, Winiker H, et al. Chronic recurrent multifocal osteomyelitis (CRMO) with symmetric involvement of both femora: X-ray, bone scintigram, and MR imaging findings in one case. J Magn Reson Imaging. 2007;26:422–6.CrossRefPubMed Buck FM, Treumann FC, Winiker H, et al. Chronic recurrent multifocal osteomyelitis (CRMO) with symmetric involvement of both femora: X-ray, bone scintigram, and MR imaging findings in one case. J Magn Reson Imaging. 2007;26:422–6.CrossRefPubMed
17.
go back to reference Borzutzky A, Stern S, Reiff A, et al. Pediatric chronic nonbacterial osteomyelitis. Pediatrics. 2012;130(5):e1190–7.CrossRefPubMed Borzutzky A, Stern S, Reiff A, et al. Pediatric chronic nonbacterial osteomyelitis. Pediatrics. 2012;130(5):e1190–7.CrossRefPubMed
18.
go back to reference Costa-Reis P, Sullivan KE. Chronic recurrent multifocal osteomyelitis. J Clin Immunol. 2013;33(6):1043–56.CrossRefPubMed Costa-Reis P, Sullivan KE. Chronic recurrent multifocal osteomyelitis. J Clin Immunol. 2013;33(6):1043–56.CrossRefPubMed
19.
go back to reference Padwa BL, Dentino K, Robson CD, et al. Pediatric chronic nonbacterial osteomyelitis of the jaw: clinical, radiographic, and histopathologic features. J Oral Maxillofac Surg. 2016;74(12):2393–402.CrossRefPubMed Padwa BL, Dentino K, Robson CD, et al. Pediatric chronic nonbacterial osteomyelitis of the jaw: clinical, radiographic, and histopathologic features. J Oral Maxillofac Surg. 2016;74(12):2393–402.CrossRefPubMed
20.
go back to reference Gonçalves BPA, Lima MG, Nogueira CD, et al. Evolution of chronic recurrent multifocal osteomyelitis in a child shown by MRI. Radiol Case Rep. 2018;14(1):58–62.CrossRefPubMedPubMedCentral Gonçalves BPA, Lima MG, Nogueira CD, et al. Evolution of chronic recurrent multifocal osteomyelitis in a child shown by MRI. Radiol Case Rep. 2018;14(1):58–62.CrossRefPubMedPubMedCentral
21.
go back to reference Fritz J, Tzaribatchev N, Claussen CD, et al. Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology. 2009;252(3):842–51.CrossRefPubMed Fritz J, Tzaribatchev N, Claussen CD, et al. Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology. 2009;252(3):842–51.CrossRefPubMed
22.
go back to reference Handrick W, Hormann D, Voppmann A. Chronic recurrent multifocal osteomyelitis—report of eight patients. Pediatr Surg Int. 1998;14(3):195, 198. Handrick W, Hormann D, Voppmann A. Chronic recurrent multifocal osteomyelitis—report of eight patients. Pediatr Surg Int. 1998;14(3):195, 198.
23.
go back to reference Iyer RS, Thapa MM, Chew FS. Chronic recurrent multifocal osteomyelitis: review. Am J Roentgenol. 2011;196:87–91.CrossRef Iyer RS, Thapa MM, Chew FS. Chronic recurrent multifocal osteomyelitis: review. Am J Roentgenol. 2011;196:87–91.CrossRef
26.
go back to reference Miettunen PM, Wei X, Kaura D, et al. Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J. 2009;7(2). https://doi.org/10.1186/1546-0096-7-2. Miettunen PM, Wei X, Kaura D, et al. Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J. 2009;7(2). https://​doi.​org/​10.​1186/​1546-0096-7-2.
27.
go back to reference Taddio A, Zennaro F, Pastore S, et al. An update on the pathogenesis and treatment of chronic recurrent multifocal osteomyelitis in children. Paediatr Drugs. 2017 Jun;19(3):165–72.CrossRefPubMed Taddio A, Zennaro F, Pastore S, et al. An update on the pathogenesis and treatment of chronic recurrent multifocal osteomyelitis in children. Paediatr Drugs. 2017 Jun;19(3):165–72.CrossRefPubMed
28.
go back to reference Beck C, Morbach H, Beer M, et al. Chronic nonbacterial osteomyelitis in childhood: prospective follow-up during the first year of anti-inflammatory treatment. Arthritis Res Ther. 2010;12(2):R74.CrossRefPubMedPubMedCentral Beck C, Morbach H, Beer M, et al. Chronic nonbacterial osteomyelitis in childhood: prospective follow-up during the first year of anti-inflammatory treatment. Arthritis Res Ther. 2010;12(2):R74.CrossRefPubMedPubMedCentral
Metadata
Title
A complicated path to the CRMO diagnosis – case of a 9 year old girl whose story comes full circle
Authors
Joanna Świdrowska-Jaros
Elżbieta Smolewska
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Osteomyelitis
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2776-9

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