Case DiscussionAcrimonious acronyms: CRMO, SAPHO and a sore shin
Section snippets
Case
A twenty-year-old young woman has recently had a baby and is now seeking advice regarding persistent shin pain. Her health has generally been well. She was hospitalized once as a 5 year old for a swelling on her clavicle that self resolved but left a visible lump. Her pregnancy was normal and her 9-month-old daughter is well. Since the pregnancy, however, she has been extremely tired and has had intermittent diarrhea, low-grade fevers and overall aching. She had initially felt it was due to the
Commentary from Dr. Michael W. Beresford
This 20-year-old woman presents with general malaise, low-grade fever and a painful inflammatory bony lesion in her tibia, unresponsive to intravenous antibiotics and with a past history of a similar clavicular lesion during early childhood. Chronic, recurrent, multifocal osteomyelitis (CRMO) is a self-limiting, relapsing, noninfectious, inflammatory condition of bone. Characteristic features include hyperostosis, which appears radiologically as osteosclerosis, and osteitis. Osteitis appears
Commentary by Dr. Andrea Deautschmann
This case presentation with a childhood history of a swollen clavicle and recurrence of bone pain at the age of twenty is suggestive of chronic, recurrent multifocal osteomyelitis (CRMO) but the differential diagnosis remains difficult, including rheumatic diseases, bacterial osteomyelitis and malignancy.
CRMO (OMIM: 259680) was first described in 1972 by Giedion et al. [3]. It is a rarely occurring nonpurulent inflammatory bone disease. At onset it often presents as a monotopic osteomyelitis.
Chronic Recurrent Multifocal Osteomyelitis
Differential Diagnosis
Bacterial osteomyelitis
Tumor
Chronic inflammatory condition
Diagnostic strategy
Clinical course
Biopsy
Technetium scan
Therapy
Symptomatic
Bisphosphonates
TNF-α inhibitors
Discussants
Michael W Beresford, MD
Institute of Child Health, University of Liverpool
Royal Liverpool Children's NHS Trust
Liverpool, UK
Andrea Deutschmann MD
Medical University of Graz
Graz, Austria
Case
Kathleen E. Sullivan, MD, PhD
The Children's Hospital of Philadelphia
University of Pennsylvania School of Medicine
References (8)
- et al.
Crohn's associated chronic recurrent multifocal osteomyelitis responsive to infliximab
J. Pediatr.
(2004) - et al.
SAPHO syndrome treated with pamidronate: an open-label study of 10 patients
Rheumatology
(2004) - et al.
Pamidronate in the treatment of childhood SAPHO syndrome
Rheumatology
(2004) - et al.
Subacute and chronic “symmetrical” osteomyelitis
Ann. Radiol.
(1972)
Cited by (3)
New insights into pustular dermatoses in pediatric patients
2014, Journal of the American Academy of DermatologyCitation Excerpt :The prognosis is good after the causative agent is discontinued.36,43 Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis are considered part of the same disease spectrum, with CRMO the most common presentation in the pediatric population.55,56 The origin of this inflammatory disorder is unknown; a susceptibility gene on chromosome 18q21.3-18q22 has been suggested.57
SAPHO syndrome with TMJ involvement: Review of the literature and case presentation
2010, International Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Clinical improvements have been demonstrated in patients treated with long-term antibiotic therapy, most often with tetracyclines and/or macrolides1,15,16,33. Using antibiotics as sole therapy has led to unpredictable results and has not been successful in most cases2,8,15,16,28,30,33–35. The efficacy of many other medications has not been fully determined8,9,12,28,34,35; including immunomodulating drugs such as methotrexate, cyclosporine, leflunomide; antitumor necrosis factor therapy using infliximab, sulfasalazine, calcitonin, and bisphosphonates6,14,16,19,29,30.
Managing bone and joint infection in children
2012, Archives of Disease in Childhood