Reumatizam, Vol. 70 No. 1, 2023.
Review article
https://doi.org/10.33004/reumatizam-70-1-4
CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS (CRMO) OF PELVIS AND SPINE IN A PAEDIATRIC PATIENT – A CASE REPORT
Stjepan Frkanec
; Department of Emergency Medicine, University Hospital Center Zagreb, Zagreb, Croatia
*
Tea Štrbac
Alenka Gagro
Ana Tripalo Batoš
Tomislav Đapić
* Corresponding author.
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO), which is the most serious type of chronic nonbacterial osteomyelitis (CNO), is a rare chronic noninfectious auto-inflammatory disease characterized by multiple sites of painful bone inflammation. Its etiology and pathophysiology is still unclear. The clinical presentation of CRMO is discerned by bone pain with typical inflammation signs and elevated inflammation parameters. Lytic and sclerotic bone lesions
can be found on X-ray scans, computed tomography (CT) and magnetic resonance imaging (MRI), but magnetic resonance imaging represents a more sensitive method of choice for determining the prognosis and stage of the disease. CRMO treatment methods include the use of non-steroidal anti-inflammatory drugs (NSAID), corticosteroids, bisphosphonates and biological therapy. In 2019, a 13-year-old boy was admitted at the University Hospital Center
Zagreb (UHC Zagreb). After several years of disease remissions and exacerbations with constant moderate pain, the correct diagnosis has been ascertained through the use of imaging methods, clinical presentation, biopsy and the exclusion of other diagnoses, The patient was monitored by a paediatric rheumatologist, and he has remained in remission following his treatment with biological therapy. CRMO should be suspected in a child with chronic and recurrent bone pain, elevated inflammatory parameters, osteolytic and osteosclerotic lesions found on X-ray, with the addition of visible bone oedema detected through MRI and the exclusion of infectious or malignant etiology. The process of establishing proper diagnoses puts an end to the unnecessary diagnostic procedures and inadequate therapy and reduces
the occurrence of disease complications. This case report could potentially prove to be helpful in establishing a proper diagnosis and treatment of patients with CRMO, but new studies about this rare and important disease would help shed some light on this topic and provide more information about this disease.
Keywords
Hrčak ID:
313704
URI
Publication date:
23.1.2024.
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