Rare presentation of chronic recurrent multifocal osteomyelitis of the Iliac wing mimicking Ewing’s sarcoma

Abstract

This report describes a case of chronic recurrent multifocal osteomyelitis (CRMO) in an 11-year-old girl, involving the iliac bone as an initial, solitary site. Atypical imaging features were suspicious of a bone tumour, such as Ewing’s sarcoma. Chronic recurrent multifocal osteomyelitis is a great masquerader and can present atypically. Radiologists should be familiar with both typical and atypical presentations, to determine an accurate diagnosis and guide appropriate management. Timely diagnosis may avoid invasive bone biopsy and inappropriate long-term antibiotic prescription for children.

Chronic Recurrent Multifocal Osteomyelitis: A Challenging Diagnosis in The Pediatric Age Group and The Role of Imaging: Sharing A Rare Clinical Experience from Ethiopia, East Africa

“…Asymmetrical lesions are also possible. Lytic lesions suggest early stage of the disease while sclerotic lesions appear in the late stage of the disease (7) Whole body scintigraphy, particularly PET may help in differentiating acute from chronic conditions. CT for assessing sterno-clavicular joint involvement in older patients is useful.…”

“…Criterion 2: if unifocal disease (other than clavicle), or CRP >30 g/L, with bone biopsy showing inflammatory changes (plasma cells, osteoclasts, fibrosis or sclerosis) with no bacterial growth whilst not on antibiotic therapy (2) This disease is known to masquerade other disease entities such as infectious osteomyelitis, SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis syndrome), Langerhans cell histiocytosis (LCH), and Ewing's sarcoma, leukemia, and storage diseases like Gaucher's disease (7,8,9). Treatment of CRMO is usually with nonsteroidal antiinflammatory drugs, where up-to 80% of cases show good response; In those cases that show poor response with the frontline regimen mentioned above; corticoids, interferon, calcitonin, azithromycin, sulfasalazine and bisphosphonates are administered a second line of treatment.…”

“…Imaging, particularly, whole-body MRI plays an important complimentary role (3,4,5). It is very challenging to differentiate this disease entity from other bone diseases like bacterial osteomyelitis, bone malignancies, or storage diseases often causing delay in instituting timely appropriate treatment (7,8,9).…”

Tubercular Osteomyelitis Mimic Ewing’s Sarcoma

“…The modality of choice for investigation is magnetic resonance imaging (MRI), and the assessment is determined through a combination of clinical and radiological follow-up to illustrate relapsing and remitting incidents [ 2 ]. However, distinguishing osteomyelitis from bone tumors remains difficult, particularly in long bones.…”