Successful treatment of chronic recurrent multifocal osteomyelitis using low-dose radiotherapy : A case report.
BACKGROUND
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disease, which lacks an infectious genesis and predominantly involves the metaphysis of long bones. Common treatments range from nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids at first onset of disease, to immunosuppressive drugs and bisphosphonates in cases of insufficient remission. The therapeutic use of low-dose radiotherapy for CRMO constitutes a novelty.


METHODS
A 67-year-old female patient presented with radiologically proven CRMO affecting the right tibia/talus and no response to immunosuppressive therapy. Two treatment series of radiation therapy were applied with an interval of 6 weeks. Each series contained six fractions (three fractions per week) with single doses of 0.5 Gy, thus the total applied dose was 6 Gy. Ten months later, pain and symptoms of osteomyelitis had completely vanished.


CONCLUSIONS
Radiotherapy seems to be an efficient and feasible complementary treatment option for conventional treatment refractory CRMO in adulthood. The application of low doses per fraction is justified by the inflammatory pathomechanism of disease.
Universitätslinik und Poliklinik für Strahlentherapie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany. christian.dietzel@uk-halle.de.
Christian T
CT
Dietzel
Universitätsklinik und Poliklinik für Innere Medizin II, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
Christoph
C
Schäfer
Universitätslinik und Poliklinik für Strahlentherapie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany.
Dirk
D
Vordermark
D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D010019:Osteomyelitis / Q000150:complications / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D010147:Pain Measurement; D061766:Proton Therapy / Q000379:methods*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D016896:Treatment Outcome
Autoimmune diseases; CRMO; Cytokines; Inflammatory diseases; Osteomyelitis; Pain; Radiotherapy