Chronic Recurrent Multifocal Osteomyelitis in Children: A Multidisciplinary Approach is needed to establish a Diagnosis

Alshammari, Alshaima; Usmani, Sharjeel; Ah, Elgazzar; Ashkanani, Rasha

doi:10.4103/1450-1147.136737

Cited by 19 publications

(16 citation statements)

References 7 publications

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“…KRMO çocuklarda görülen enfektif olmayan enflamatuvar bir osteomiyelit çeşitidir. İnsidansı ve prevalansı ile ilgili geniş çaplı bir epidemiyolojik çalışma olmamakla birlikte insidansının 1:1 000 000 olduğu düşünülmektedir (5). Genellikle uzun kemiklerin metafizleri tutulsa da omurga, pelvis ve omuz da tutulan kemikler arasındadır.…”

Section: Discussionunclassified

“…Ayrıca eklemlerin ve yumuşak dokuların değerlendirilmesinde oldukça duyarlı yöntem olan MRG'de hem osteomiyelitin gösterilmesinde hem de hastalığın ayırıcı tanısının yapılmasında oldukça faydalıdır. Hastalığın ayırıcı tanısında osteosarkom ve Ewing's sarkomu gibi maligniteler ve bakteriyel subakut osteomiyelit olduğu unutulmamalıdır (1,(3)(4)(5). Bizim olgumuzda da herhangi bir mikroorganizma izole edilemedi.…”

Section: Discussionunclassified

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Kronik Rekürren Multifokal Osteomiyelit

Arici¹,

Çağan²,

Çağan³

2019

J Pediatr Inf

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Kronik rekürren multifokal osteomiyelit (KRMO) etyolojisi tam aydınlatılamamış, nadir görülen enfeksiyöz olmayan enflamatuvar kemik hastalığıdır. Hastalık tekrarlayan kemik ağrısı ve ateş atakları ile seyreder. Klinik olarak bakteriyel osteomiyeliti taklit etse de kültürlerde üreme olmaz ve antibiyotik tedavisine yanıt vermez. Bu yazıda bilateral kronik bacak ağrısı ve şişlik şikayeti ile başvuran ve KRMO tanısı alan 11 yaşında bir kız olguyu sunduk. Bu olgu sebebi ile tekrarlayan, multifokal kemik ağrısı olup osteomiyelit kliniği olan hastalarda KRMO'nun ayrıcı tanıda düşünülmesi gerektiğini vurgulamak istedik.

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Section: Discussionunclassified

Kronik Rekürren Multifokal Osteomiyelit

Arici¹,

Çağan²,

Çağan³

2019

J Pediatr Inf

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“…Other nonmusculoskeletal disorders related to CRMO include arthritis, palmoplantar pustulosis, Crohn's disease, growth hormone deficiency and psoriasis (15). Elevated ESR is the most remarkable laboratory finding, but anemia and leukocytosis are not detected and also tissue and blood cultures are negative (8).…”

Section: Discussionmentioning

confidence: 99%

“…Lesions typically affect metaphyseal region of long bones but can occur in any bone (such as clavicle) (5)(6)(7). Apart from the bone, other organs such as lungs, gastrointestinal tracts and the eyes can also be involved (8). CRMO should be diagnosed with caution.…”

Section: Introductionmentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis: A Case Report

et al. 2017

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Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare migratory skeletal disorder with non-infectious inflammatory etiology which usually causes bone pain in children and adolescents. Intermittent periods of exacerbation and remission are usually noted during the course of the disease. It is a multifocal bone disease usually involving the metaphyses of long bones. The clinical and Paraclinical findings are non-specific, and indeed CRMO is a diagnosis of exclusion based on multiple criteria. Case Presentation: We present a 6-year-old boy with multiple periods of fever, systemic inflammation and bone pain since he was 2 years old, hospitalized multiple times, received antibiotics and finally diagnosed as a CRMO case. Conclusions: CRMO should be diagnosed according to a variety of clinical and paraclinical findings. In children and adolescents with multiple bone lesions and lytic lesion, one of the differential diagnoses that should be considered is CRMO.

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“…5 The differential diagnosis includes chronic infectious osteomyelitis, Ewing sarcoma, and Langerhans histiocytosis among other conditions. 6 Radiography of the symptomatic regions may show osteolytic lesions affecting long bone metaphyses, but this finding is neither sensitive nor specific for CRMO. Whole-body bone scintigraphy is useful for identifying other affected sites and is more sensitive than radiography for detecting inflammatory bone lesions, whereas MRI provides better anatomic definition of the affected bone and soft tissue.…”

mentioning

confidence: 98%

Chronic Recurrent Multifocal Osteomyelitis and Thalidomide in Chronic Granulomatous Disease

Martin‐Nalda¹,

Roca²,

Fontecha³

et al. 2016

Pediatrics

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Chronic granulomatous disease (CGD) is a primary immunodeficiency that leads to severe recurrent infection and inflammatory complications that are usually difficult to diagnose and treat. Several hyperinflammation mechanisms, such as decreased neutrophil apoptosis, toll-like receptor activation imbalance, Th17 cell induction, Nrf2 activity deficiency, and inflammasome activation, have been described in CGD patients However, there have been no reports of chronic recurrent multifocal osteomyelitis as an inflammatory complication in CGD, and the differential diagnosis of this condition with infectious osteomyelitis is challenging. Thalidomide has been used to treat several inflammatory manifestations in CGD patients with good clinical results. Here, we report the case of a previously asymptomatic 11-year-old boy who consulted for difficulty walking and pain at the back of the right thigh, with increased inflammatory markers. Multifocal bone involvement was seen on bone scintigraphy, and acute-phase reactants were elevated. On the basis of a suspected diagnosis of infectious osteomyelitis, broad-spectrum antibiotic therapy was started, with no clinical response. Bone biopsy and microbiological tests yielded negative results; at that point, chronic recurrent multifocal osteomyelitis was suspected. The patient was unresponsive to nonsteroidal antiinflammatory drugs and corticosteroids. Thalidomide was started, and within 6 months, clinical and radiologic resolution of the condition was achieved with no adverse effects. More than 1 year after stopping thalidomide, the patient remained free of symptoms and inflammatory parameters are within normal levels. Thalidomide has a favorable safety profile compared with other alternatives and could be considered a feasible therapeutic option for this type of condition in selected patients.

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Chronic Recurrent Multifocal Osteomyelitis in Children: A Multidisciplinary Approach is needed to establish a Diagnosis

Cited by 19 publications

References 7 publications

Kronik Rekürren Multifokal Osteomiyelit

Kronik Rekürren Multifokal Osteomiyelit

Chronic Recurrent Multifocal Osteomyelitis: A Case Report

Chronic Recurrent Multifocal Osteomyelitis and Thalidomide in Chronic Granulomatous Disease

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