Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated?
BACKGROUND
Chronic recurrent multifocal osteomyelitis (CRMO) is the most severe form of chronic nonbacterial osteomyelitis. In children and adolescents, chronic nonbacterial osteomyelitis predominantly affects the metaphyses of the long bones, but lesions can occur at any site in the skeleton. Other organs (the skin, eyes, gastrointestinal tract and lungs) can also be affected. Clinical diagnosis is often difficult because the symptoms and course of disease vary significantly. We present a 10-year-old girl diagnosed with CRMO involving several vertebrae, the femur and the metatarsus.


METHODS
Physical examination, abdominal ultra sonography, conventional X-ray, MRI, technetium bone scan, esophagogastroduodenoscopy, colonoscopy, tests for HLA-B27 and thiopurine methyltransferase, polymerase chain reaction and thoracic vertebral bone biopsies.


METHODS
CRMO and Crohn's disease.


RESULTS
The patient's condition improved whilst being treated with NSAIDs for 3 months; however, the patient had an allergic skin reaction to this therapy. Treatment was switched to sulfasalazine, accompanied by 3 weeks of therapy using oral prednisone, but sulfasalazine was discontinued 2 months later because the patient exhibited a minor elevation in the levels of liver enzymes. The patient was free of musculoskeletal symptoms for 6 months, at which time she started to complain again about pain in her back and bowel. Multimodal therapy, consisting of mesasalazine, corticosteroids (budesonide) and azathioprine, induced clinical remission of Crohn's disease.
Children's Hospital, University of Wuerzburg, Josef-Schneider-Strasse 2, Wuerzburg, 97080, Germany. hermann.girschick@mail.uni-wuerzburg.de
Hermann J
HJ
Girschick
Christiane
C
Zimmer
Guenter
G
Klaus
Kassa
K
Darge
Anke
A
Dick
Henner
H
Morbach
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D005269:Femur / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008684:Metatarsus / Q000473:pathology; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D013904:Thoracic Vertebrae / Q000473:pathology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents