Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder that primarily affects children with recurrent episodes of sterile osteomyelitis in one or more bones. Patients usually present with recurrent bone pain, though it is often a diagnosis of exclusion with most patients undergoing extensive work-up to arrive at a diagnosis.
Clinical Findings: This 15-year-old female presented with months of progressive multifocal bone pain, 22-pound weight loss and recurrent fevers. Work-up as an outpatient included a positive screening assay and IgM Western blot Panel positive for Lyme disease, treated with a 28-day course doxycycline without resolution of the symptoms, elevated inflammatory markers and normocytic anemia. She was admitted for further workup when pain progression prevented ambulation.
Diagnoses, Interventions and Outcomes: The patient was treated with ketorolac with notable improvement in pain. Labs were unrevealing for underlying infection, autoimmune or hematologic etiology. Spinal MRI demonstrated a compression deformity of her 4th cervical vertebra as well as multifocal bone marrow signal abnormalities. Percutaneous CT-guided core needle biopsy of the manubrium was performed and was consistent with CRMO. Bacterial culture from the bone biopsy grew Cutibacterium (formerly Propionibacterium) acnes. She was discharged on naproxen with some improvement in pain and subsequently received antibiotic treatment when bone culture resulted positive.
Conclusions: This case illustrates an unusual presentation of CRMO and emphasizes that it should be on the differential for patients with ongoing bone pain, weight loss and anemia. Multi-disciplinary approach is necessary and early suspicion is important in determining appropriate diagnostic evaluation and targeted treatment.
Martens, Anna M.; Ezzio, Catherine; Goddard, Amanda; and Mallory, Leah
"Multifocal Bone Pain, Recurrent Fevers and Anemia in a 15-Year-Old,"
Journal of Maine Medical Center: Vol. 2
, Article 12.
Available at: https://knowledgeconnection.mainehealth.org/jmmc/vol2/iss2/12