Chronic recurrent multifocal osteomyelitis (CRMO) involving spine: A case report and literature review

Yamashita, Kazuo; Calderaro, Cosma; Labianca, Luca; Gajaseni, Pawin; Weinstein, Stuart L.

doi:10.1016/j.jos.2018.06.015

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…First, the patient might receive several prolonged and unnecessary courses of treatment, such as antibiotics (13). In our case, the patient had received various antibiotics, and was on the treatment with Linezolid, which is mostly used for resistant, complicated and hospital-acquired infections (19).…”

Section: Discussionmentioning

confidence: 88%

“…There have been many case reports and case series of patients with atypical involvement (4,10,11). For instance, patients with acute vertebral deformities (12), chronic painful scoliosis (13), and chronic mandible involvement as their only presentation (9). This variety has been considerable, to the point that some studies have proposed classi cation of CRMO cases into subgroups based on their presented phenotypes, such as spinal or axial versus peripheral form (14,15).…”

Section: Discussionmentioning

confidence: 99%

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Chronic Recurrent Multifocal Osteomyelitis with an uncommon presentation and disabling features: A case report

Shahin

Asnaashari

Zarei

et al. 2022

Preprint

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Background: Chronic recurrent multifocal osteomyelitis (CRMO) is one of the auto-inflammatory bone disorders with yet to be determined etiology. Due to overlapping signs and symptoms with other bone involvements, the diagnosis of this disease might take a long period of time and the patients may develop deformities in long-term. Thus, increasing awareness about different presentations of the disease seems beneficial.Case presentation: A 12-year-old boy was referred to our center with severe back pain in his thoracic vertebrae from 18 months before referral. He had previously undergone two vertebroplasty surgeries due to his kyphosis and had received several courses of antibiotics, which resulted in no improvement in his disabling pain. His physical examination was unremarkable, except for severe thoracic vertebrae tenderness and a mild dextroscoliosis. MRI showed diffuse multiple hypo-signal lesions in thoracic vertebral bodies with slight enhancement, causing compression fractures of T8, T11 and T12 bodies. Bone scan revealed increased activity in thoracic region (T7-T8-T9-T12 vertebral bodies) and left clavicle. Other differentials were ruled out by bone marrow aspiration, bone biopsy and laboratory tests. His disease showed a favorable response to treatment with Pamidronate, Methotrexate and Indomethacin and he had no relapse in three years of follow-up.Conclusions: Uncommon presentations of CRMO can be misleading to the specialists and might result in prolonged diagnosis process. Increased awareness among different specialists about such presentations can potentially lead to earlier diagnosis, and timelier and more effective treatment of the CRMO patients.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis with an uncommon presentation and disabling features: A case report

Shahin

Asnaashari

Zarei

et al. 2022

Preprint

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“…Based on our clinical experiences, long bone lesions in diaphyses are more easily improved than those in epiphyses. It is worth noting that, spinal involvement can lead to fractures and secondary bone deformity [ 37 ]. This emphasizes the need for early diagnosis and aggressive treatment to prevent complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of chronic nonbacterial osteomyelitis in children: a multicenter case series

Liu

Tang

et al. 2022

Pediatr Rheumatol

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Objective The aim of this study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of children with Chronic nonbacterial osteomyelitis (CNO). Methods Retrospective multi-center case series study of pediatric patients diagnosed with CNO treated at five tertiary centers in south China. Results Totally there were 18 patients diagnosed as CNO between 2014 and 2020. The median age of onset was 9.2 years (range 3.7–13.1) and 55.6% were female. Median delay in diagnosis was 10.9 months (range 1.0–72.0). The most frequent presenting symptoms were bone pain (100%) and fever (44.4%). Most patients had more than one lesion (median of 5, range 1–7). Most frequently affected bones were tibiofibula (88.9%) and femur (77.8%). The MRI characteristics mainly presented as bone edema and hyperintensity in bone marrow. Bone biopsy was conducted in 11 patients (61.1%) with inflammatory cells infiltration manifested as chronic osteomyelitis, and none showed bacterial infection or tumor. In treatment, non-steroid anti-inflamatory drugs (NSAIDs) is used as the first-line drug followed by steriods, methotexate (MTX), salazosulfadimidine (SASP), Bisphosphonates and TNF-α inhibitor. Two refractory cases received combination therapy with Bisphosphonates and TNF-α inhibitor, and achieved good therapeutic effect. Conclusions The present study described a multicenter series of CNO from south China and highlighted the clinical features, laboratory tests, imaging characteristics and treatment outcomes. Increasing awareness of this disease is important to decrease time to diagnosis, improve access to treatment, and reduce complications.

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“…Comorbid conditions found in CRMO may include spondyloarthropathy, psoriatic arthritis as well as Inflammatory Bowel Disease (Crohn's disease or ulcerative colitis). Comorbid conditions can be absent in the onset of the disease and appear after 1 to 5 years of evolution [4,5]. SAPHO is also characterized by episodic recurrent bone pain due to non-bacterial osteitis [6].…”

Section: Discussionmentioning

confidence: 99%

Non-bacterial osteitis: Chronic Recurrent Multifocal Osteomyelitis or pediatric SAPHO?

2020

JMR

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Chronic Recurrent Multifocal Osteomyelitis (CRMO) and SAPHO syndrome represent the group of autoinflammatory bone disease responsible for recurrent non-bacterial osteitis (NBO). both are considered as defects of innate immunity. The most common clinical presentation is recurrent episodes of bone pain with or without fever.The clinical and imaging features are non-specific.This usually leads to late and confusing diagnosis. We hereby report a case of CRMO in a 12-year-old patient. The aim is to highlight the confusing overlap of clinical features between CRMO and SAPHO syndromes. Keywords: multifocal osteomyelitis, non-bacterial osteitis, SAPHO, bone pain.

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Chronic recurrent multifocal osteomyelitis (CRMO) involving spine: A case report and literature review

Cited by 12 publications

References 21 publications

Chronic Recurrent Multifocal Osteomyelitis with an uncommon presentation and disabling features: A case report

Chronic Recurrent Multifocal Osteomyelitis with an uncommon presentation and disabling features: A case report

Clinical characteristics and outcomes of chronic nonbacterial osteomyelitis in children: a multicenter case series

Non-bacterial osteitis: Chronic Recurrent Multifocal Osteomyelitis or pediatric SAPHO?

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