Chronic recurrent multifocal osteomyelitis: 17 case reports and literature review

Objective

To analyse the clinical presentation of chronic recurrent multifocal osteomyelitis (CRMO) and to review diagnostic criteria.

Study design

We reviewed the medical charts of 17 patients with CRMO and we compared with 107 cases reported in literature.

Results

CRMO primarily affects girls with a mean age at onset of 8.5 years and a mean time to diagnosis of 8.5 months. Most patients were diagnosed in less than 1 month, but 2 cases presented a delay due to atypical presentation. At onset, 14 patients had inflammatory pain and 6 local swelling and fever. The lower limbs were predominantly affected, followed by the axial skeleton, the upper limbs and lastly by the mandible. Laboratory parameters provided non-specific information on CRMO. Radiographic studies were needed to exclude other pathologies. The diagnosis should be reached by isotope bone scanning or by magnetic resonance imaging. In doubt case bone biopsy was request to confirm the diagnosis.

Conclusion

We propose the following criteria for CRMO diagnosis: 1) acute or insidious onset of multifocal bone pain accompanied by fever and/or swelling 2) bone scans evidence of multifocal bone lesions 3) evidence of chronic bone inflammation with exclusion of other diseases at biopsy, in doubt cases.