Chronic Relapsing Multifocal Osteomyelitis

CRMO

 

Very rare

- Mainly affects children

 

Characterised by multiple osteomyelitic changes

- predominantly in metaphyseal region of long bones

 

All cultures negative

 

Antibiotics do not affect course of disease

 

Pain is most common symptom

- Occasional soft tissue swelling

 

Criteria

 

Two or more radiologically confirmed bone lesions

Course of over 6 month, with exacerbations and remissions

Radiographic and nuclear scintigraphic evidence of osteomyelitis 

Lack of response to over one month of antibiotic treatment

Lack of identifiable aetiology

 

Haematological Examination

 

ESR usually elevated  (25 - 75 mm/hour)

CRP usually elevated  (10 - 85 g/l)

White cell count usually unremarkable

Gamma globulins sometimes slightly elevated

Immunodeficiency tests normal

 

Management

 

NSAIDs 

Steroids may be of some benefit

Interferon used in severe cases

 

Prognosis 

 

Usually protracted course

Usually self limited

 

Differential

 

Viral polyarthritis

Juvenile chronic arthritis

Acute osteomyelitis

Neoplasia

- Neuroblastoma

- Leukaemia

- Rhabdomyosarcoma

Langerhans cell histiocytosis

 

Garre's Primary Sclerosing Osteomyelitis

 

Fevers

ESR raised

Usually one site

2nd lesion may occur years later

Hot on bone scan

Same age group as CRMO

 

Histology

- chronic osteomyelitis

- Biopsy sterile

 

Lesions predominantly sclerotic

 

Recurrent symptoms

 

? Unifocal form of CRMO