Diagnostic options in chronic recurrent multifocal osteomyelitis: Case reports

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is the most severe form of chronic non-bacterial osteomyelitis. In children and adolescents, the metaphyses of long bones are affected most frequently, but the lesions can be found at any site on the skeleton, as well as in other organs such as the skin, eyes, gastrointestinal tract or lungs. Since the clinical signs of CRMO and its course are not invariable and clear, it is often very difficult to make a clinical diagnosis. The authors present their experience with the CRMO diagnosis in three cases. In the first patient, CRMO was localised in the left proximal tibia, left proximal femur, left sacrum and left clavicle bone. In the second patient, it was found in the left distal tibia, tarsometatarsal joints of the left foot and left distal femur. The third patient showed lesions in the inferior pubic ramus and ischial bone on the left side. With interdisciplinary co-operation it was possible to make the exact diagnosis of CRMO in all three female patients, and the disease was successfully managed. A precise therapeutic procedure could be derived from the results of randomised controlled studies which, however, cannot be made because of an infrequent occurrence of this disease. A meta-analysis of the cases so far published in the literature would be a more likely option.