Chronic Recurrent Multifocal Osteomyelitis: A Distinct Clinical Entity

Gamble, James G.; Rinsky, Lawrence A.

doi:10.1097/01241398-198609000-00010

Cited by 95 publications

(63 citation statements)

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“…These conditions are usually recurrent and may be associated with skin infections. 22,[24][25][26][27][28] Although multifocal lesions were seen in this and other studies, 13,14 the lesions resolved with treatment, and were not recurrent or associated with skin changes. The recommended treatment for subacute osteomyelitis with a lucent lesion or nidus has been curettage, biopsy and culture followed by immobilisation and antibiotics.…”

Section: Discussionmentioning

confidence: 80%

Primary subacute haematogenous osteomyelitis in children

Rasool

2001

The Journal of Bone and Joint Surgery. British volume

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Between 1990 and 1998 we saw 21 children with primary subacute haematogenous osteomyelitis. Pain, swelling and a limp had been present for two to 12 weeks with little functional impairment. Laboratory tests were non-contributory. The lesions were classified radiologically into metaphyseal, diaphyseal, epiphyseal and vertebral. There were 24 sites involved, with most (20) being in the tibia; 17 lesions were in the diaphysis, five in the metaphysis and two in the epiphysis. The diagnosis was confirmed histologically in all cases. Staphylococcus aureus was cultured in six patients. Healing occurred in all patients after treatment with antibiotics for six weeks and radiological improvement was seen after three to six months.Subacute osteomyelitis develops as a result of increased host resistance and decreased bacterial virulence. The radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections. Histological confirmation is necessary to avoid a delay in diagnosis. J Bone Joint Surg [Br] 2001;83-B:93-8.

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Section: Discussionmentioning

confidence: 80%

Primary subacute haematogenous osteomyelitis in children

Rasool

2001

The Journal of Bone and Joint Surgery. British volume

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“…CRMO is regarded by some to be part of a spectrum of disease with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome, whereas others consider it to be a separate clinical entity [12,13]. Some consider CRMO to be the pediatric presentation of SAPHO syndrome, which generally affects adults, although as in this case, CRMO-like presentations can occur in adults.…”

Section: Discussionmentioning

confidence: 93%

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

et al. 2015

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We present the case of a 33-year-old man with no significant medical history who developed right scapular pain, left-sided sacroiliac joint pain, and lower back pain, and was eventually diagnosed with chronic recurrent multifocal osteomyelitis (CRMO). Imaging demonstrated multiple scattered T2-hyperintense lesions on MRI at the spine and the left SI joint, some of which progressed and one regressed in size on follow-up. Histopathology demonstrated only non-specific chronic inflammation compatible with CRMO. No evidence of infectious organisms or neoplastic processes was found. The pain was relapsing and remitting in nature. Laboratory investigations were notable for no evidence of hematologic malignancy or infection, but only a mild increase in alkaline phosphatase. This case highlights that CRMO, despite being thought of as a childhood-onset disease, can present in adults as well, and also provides illustrative examples of imaging and histological findings.

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“…3 The disease is rare, accounting for 2% to 5% of all osteomyelitis cases, and primarily affects young girls, with a female/male ratio of 5:1. In a 5-year follow-up study of 23 patients published in 2002, the median age of onset was 10 years with a reported range of 4 to 14 years.…”

Section: Discussionmentioning

confidence: 99%

“…The multifocality of disease involvement, the typically negative cultures of bone, and the remitting-relapsing nature of the disorder distinguish CRMO from subacute bacterial osteomyelitis. 3 The following diagnostic criteria were proposed by Manson et al 21 in 1989: 1) Ն2 radiographically confirmed bone lesions; 2) at least 6 months of remissions and exacerbations of signs and symptoms; 3) radiographic and bone scan evidence of osteomyelitis; 4) lack of response to antimicrobial therapy at least 1 month in duration; and 5) lack of an identifiable cause.…”

Section: Discussionmentioning

confidence: 99%

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Chronic Recurrent Multifocal Osteomyelitis of the Spine and Mandible: Case Report and Review of the Literature

Chun

2004

Pediatrics

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ABSTRACT. At initial presentation, chronic recurrent multifocal osteomyelitis may mimic acute hematogenous osteomyelitis; however, cultures of affected bone are sterile. Nuclear scintigraphy identifies additional foci of involvement that present concurrently or sequentially. Unlike acute bacterial osteomyelitis, chronic recurrent multifocal osteomyelitis seems unaffected by antibiotic therapy and typically responds to treatment with antiinflammatory drugs. Surgical decortication has been reported for refractory cases. The case presented here illustrates the rare involvement of the mandible after initial presentation in the spine of a 4-year-old girl and the refractory nature of the disease over 6 years despite treatment with various medical and surgical therapies. Pediatrics 2004;113:e380 -e384. URL: http://www.pediatrics. org/cgi/content/full/113/4/e380; bone diseases, osteitis, hyperostosis.ABBREVIATIONS. CRMO, chronic recurrent multifocal osteomyelitis; MRI, magnetic resonance imaging; ESR, erythrocyte sedimentation rate; CT, computed tomography; AFB, acid-fast bacilli; Ig, immunoglobulin; PCR, polymerase chain reaction; DSO, diffuse sclerosing osteomyelitis; SAPHO, synovitis, acne, palmoplantar pustulosis, hyperostosis, osteitis syndrome. G iedion et al 1 first described acquired, culturenegative, multifocal osteomyelitis in children in 1972 and named the syndrome "subacute and chronic symmetrical osteomyelitis." In the original report, the disorder involved the metaphyses of long bones either simultaneously or successively. Subsequent publications reported involvement of additional bone sites and referred to the disorder as chronic multifocal osteomyelitis 2 and chronic recurrent multifocal osteomyelitis (CRMO). 3 Pediatric cases with mandibular involvement have been reported in the oral surgery, radiology, orthopedics, and dermatology literature.Unlike the previously reported 4 cases of CRMO with mandibular involvement in the English-language literature, 4 -7 this patient developed CRMO initially in the spine and thereafter developed mandibular involvement. She did not have prior dental infection or skin manifestations associated with CRMO. Additional aspects of interest include the progressive nature of the mandibular involvement and the disease refractoriness to different therapies over 6 years. CASE REPORT Year 1In February 1997, a previously healthy, 4-year, 2-month-old white female was seen in the clinic for left-sided lumbar pain and a fever to 104°F. There was no history of trauma, and the examination was normal. She was treated for muscle strain with ibuprofen. Over the next 3 months, the pain persisted and woke her at night, and she refused to run or jump. A bone scan revealed increased uptake at the left side of the S1 vertebra on delayed images. Magnetic resonance imaging (MRI) revealed a well-circumscribed, irregularly shaped lytic lesion of S1 extending into the sacral ala (Fig 1). Her erythrocyte sedimentation rate (ESR) was 27 mm/hour, and she underwent a computed tomography (CT)-guided perc...

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Chronic Recurrent Multifocal Osteomyelitis: A Distinct Clinical Entity

Cited by 95 publications

References 0 publications

Primary subacute haematogenous osteomyelitis in children

Primary subacute haematogenous osteomyelitis in children

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

Chronic Recurrent Multifocal Osteomyelitis of the Spine and Mandible: Case Report and Review of the Literature

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