title: Chronic recurrent multifocal osteomyelitis causing an acute scoliosis.
abstract: Study Design. A Case Report. Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO). Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine. Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR) sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved. Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding. Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.
authors.affiliation: Department of Spinal Surgery, Musgrove Park Hospital, Taunton, Somerset TA1 5DA, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Armstrong
authors.forename: Neil
authors.initials: N
authors.lastname: Upadhyay
authors.forename: Edward
authors.initials: E
authors.lastname: Saxby
authors.forename: Damian
authors.initials: D
authors.lastname: Pryce
authors.forename: Nick
authors.initials: N
authors.lastname: Steele