title: [Chronic recurrent multifocal osteomyelitis of the mandible: report of three cases].
abstract: OBJECTIVE
  To report three cases of chronic recurrent multifocal osteomyelitis of the mandible, an inflammatory disease affecting one or more bones with absence of isolated microorganisms in affected areas.
  
  
  METHODS
  The first case is a 13 year-old female presenting with pain and fever after dental treatment. The patient received antibiotic treatment for osteomyelitis, but developed progressive enlargement of the mandible and palmoplantar pustulosis. Bone scintigraphy showed intense and diffuse uptake in the mandible. The swelling decreased after indomethacin and hyperbaric oxygen therapy. Case 2 is a 9 year-old female patient with recurrent pain and edema of the right mandible for three years. The diagnosis of osteomyelitis was established and amoxicillin introduced. After three months, tomography showed diffuse mandible osteolysis. Indomethacin and hyperbaric oxygen therapy were introduced, however the patient presented a relapse and was treated with prednisone, rofecoxib and methotrexate. Patient 3, a 10 year-old male, had palmoplantar pustulosis and recurrent enlargement of the mandible. Tomography showed diffuse mandible osteolysis and scintigraphy revealed intense and diffuse uptake in the mandible. The patient was treated with prednisone. Rofecoxib was replaced after two relapses.
  
  
  CONCLUSIONS
  Chronic recurrent multifocal osteomyelitis of the mandible is often associated with prolonged pain periods and periods of activity and remission of the inflammatory process. Its recognition is important to prevent the patient from being submitted to prolonged antibiotic therapy and unnecessary invasive procedures.
authors.affiliation: Unidade de Reumatologia Pediátrica, Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo.
authors.forename: Luciana B
authors.initials: LB
authors.lastname: Paim
authors.forename: Bernadete Lourdes
authors.initials: BL
authors.lastname: Liphaus
authors.forename: André C
authors.initials: AC
authors.lastname: Rocha
authors.forename: Aura Ligia Z
authors.initials: AL
authors.lastname: Castellanos
authors.forename: Clovis Artur A
authors.initials: CA
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible; D008336:Mandibular Diseases / Q000188:drug therapy / Q000473:pathology*; D010019:Osteomyelitis / Q000473:pathology* / Q000628:therapy; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents