Chronic recurrent multifocal osteomyelitis; a case report and review of literature

A ۶-year-old girl was referred to the pediatrics rheumatology department of the Bahonar Children Hospital (Karaj- Iran) with the chief complaint of right pelvis, knee, leg pain, and left shoulder pain. She mentioned she had three months history of right pelvis pain, which worsened at night and woke up the patients. Also, her parents mentioned limping. She scored the pelvis pain ۸ out of ۱۰. In addition, she mentioned right knee pain (VAS = ۱۰), which was disseminated to the groin and lower leg two months ago. She noticed that left shoulder pain started six weeks ago, and she scored the shoulder pain ۹ out of ۱۰. She was the firstborn of non-related parents. She was a term at born (gestational age = ۳۸ weeks) and delivered by c-section. She had no notable history of childhood illness or familial history. Erythematous swelling was seen on the one-third proximal portion of the left clavicle. Also, she had tenderness on palpation at this portion. She did not have any tenderness in her right knee and groin. Extremities had normal motion range. She has leukocytosis, erythrocyte sedimentation rate (ESR) higher than the average range, and elevated C-reactive protein (CRP). Blood and urine cultures were negative. MRI revealed an abnormal lesion of about ۴۵ mm in length and a periosteal reaction in the left clavicle. Also, it showed a ۱۳*۸ mm sclerotic lesion in the right femoral metaphysis. Scintigraphy performed by Tc۹۹ showed increased tracer uptake in the right femoral neck next to the epiphyseal line as well as the left clavicle. The specimen for histopathological examination was achieved from her left clavicle bone by an orthopedic surgeon. Histopathological examination diagnosed the specimen with CRMO/CNO, and the pathologist mentioned that there was no suggesting evidence of malignancy. She was prescribed with Naproxen and prednisolone (۵ mg daily). After blood sugar monitoring, we revealed moderate to severe hyperglycemia. So, prednisolone was tapered and she was prescribed with methotrexate (۱۰ mg/m (۲)/week orally) and Naproxen.

کلیدواژه ها:

Chronic non-bacterial osteomyelitis ، CNO ، Chronic recurrent multifocal osteomyelitis ، CRMO