Chronic recurrent multifocal osteomyelitis in pediatrics: A diagnostic challenge

We present the case of a 14-year-old male with a 2-week history of pain located at the tibial metaphysis and fever. X-ray revealed a lytic lesion in the tibial metaphysis. MRI revealed an intramedullary bone lesion with perilesional bone oedema. CT-guided biopsy discounted malignancy and microbiological cultures were negative. The patient's symptoms and fever worsened after the biopsy; therefore antibiotherapy was commenced for a suspected superinfection. A body MRI was performed given the persistence of the fever, which found a second active lesion in the spine that was diagnosed as CRMO and progressed well with anti-inflammatories. CRMO is an entity that is difficult to diagnose. Differential diagnosis is extensive with infectious diseases, tumours and other autoinflammatory diseases. Prompt diagnosis and appropriate treatment are crucial to prevent sequelae.ResumenLa osteomielitis crónica multifocal recurrente (OMCR) es una enfermedad autoinflamatoria que cursa con inflamación ósea aséptica y puede acompañarse de clínica multisistémica. Presentamos el caso de un varón de 14 años con dolor a nivel de la metáfisis tibial de 2 semanas de evolución y fiebre. En la radiografía se objetivó lesión lítica en metáfisis tibial. Se realizó RM que mostró lesión ósea intramedular con oedema óseo perilesional. Se realizó biopsia guiada por TAC descartando malignidad y siendo los cultivos microbiológicos negativos. Posterior a la punción presentó empeoramiento cl...
Source: Revista Espanola de Cirugia Ortopedica y Traumatologia - Category: Orthopaedics Source Type: research