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Yasin S, Sato TS, Ferguson P. Not all benign: disease course, complications, and sequalae of chronic recurrent multifocal osteomyelitis in children. Curr Opin Rheumatol 2022; 34:255-261. [PMID: 35797524 DOI: 10.1097/bor.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Advances in pathogenesis of chronic recurrent multifocal osteomyelitis in children (CRMO) have shaped therapeutic strategies. The use of whole-body MRI (WBMRI) and improved awareness of CRMO has increased rates and timeliness of CRMO diagnoses. In this review, we highlight the findings from recently published CRMO cohorts and describe the course, complications, and long-term sequalae of CRMO. It is important for clinicians to be aware of the potential for long-term sequelae in order to optimize therapy and avoid complications. RECENT FINDINGS Despite recent advances in defining disease pathogenesis, children with CRMO continue to suffer from complications and deformities. Involvement of the spine can be asymptomatic and is not as rare as previously suggested. This can result in damaging outcomes, such as vertebral fractures and permanent deformities. A subset of patients has polycyclic disease course and some continue to have active disease for years and well into adulthood, with significant impacts on quality of life. SUMMARY These recent findings have considerable implication on clinical practice regarding diagnosis, treatment, and monitoring of the disease. Collectively, they support the need for continued monitoring of the disease and screening using comprehensive imaging, such as WBMRI.
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Affiliation(s)
- Shima Yasin
- Division of Pediatric Rheumatology, Allergy, and Immunology, Department of Pediatrics
| | - T Shawn Sato
- Divisions of Pediatric and Neuroradiology, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Polly Ferguson
- Division of Pediatric Rheumatology, Allergy, and Immunology, Department of Pediatrics
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Franco-Jiménez S, Romero-Aguilar JF, Bervel-Clemente S, Martínez-Váquez M, Alvarez-Benito N, Grande-Gutiérrez P, Maldonado-Yanza RG. [Garre's chronic sclerosing osteomyelitis with sacral involvement in a child]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:145-9. [PMID: 23608216 DOI: 10.1016/j.recot.2012.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/04/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022] Open
Abstract
We report the case of a 6 year old patient who started with abdominal pain and left sciatica, which did not improve after applying symptomatic treatment. A complete analytical and imaging study was performed, which showed a lesion in left S1 corresponding to Garrè's chronic diffuse sclerosing osteomyelitis. The diagnosis was confirmed by biopsy of the lesion. Treatment was established with corticosteroids and anti-inflammatory drugs, obtaining a clinical improvement, although in the follow-up imaging tests 2 years after the onset of the symptoms, the lesion persists but with a significant reduction in its size.
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Affiliation(s)
- S Franco-Jiménez
- Cirugía Ortopédica y Traumatología, Hospital Infanta Elena, Huelva, España.
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Garre's chronic sclerosing osteomyelitis with sacral involvement in a child. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2012.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Khanna G, Sato TSP, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 2009; 29:1159-77. [PMID: 19605663 DOI: 10.1148/rg.294085244] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder of children and young adults that is characterized by nonbacterial osteomyelitis. Patients typically present with multifocal bone pain secondary to sterile osseous inflammation, and the disease has a relapsing and remitting course. The cause of CRMO remains unclear, although the results of several studies have suggested a genetic component. The typical imaging findings of CRMO include lytic and sclerotic lesions in the metaphyses of long bones and the medial clavicles. Other common sites of disease are the vertebral bodies, pelvis, ribs, and mandible. CRMO is often bilateral and multifocal at presentation. Owing to the lack of a diagnostic test, CRMO remains a diagnosis of exclusion. Although generally a self-limiting disease, CRMO can have a prolonged course and result in significant morbidity. Radiologists can be the first to suggest this diagnosis given its characteristic radiographic appearance and distribution of disease. Radiologists should be familiar with the typical imaging findings of CRMO to prevent unnecessary multiple biopsies and long-term antibiotic treatment in children with CRMO.
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Affiliation(s)
- Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, St Louis, MO 63110, USA.
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Deogaonkar K, Ghandour A, Jones A, Ahuja S, Lyons K. Chronic recurrent multifocal osteomyelitis presenting as acute scoliosis: a case report and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 17 Suppl 2:S248-52. [PMID: 17912555 PMCID: PMC2525918 DOI: 10.1007/s00586-007-0516-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Revised: 08/31/2007] [Accepted: 09/17/2007] [Indexed: 10/22/2022]
Abstract
Chronic relapsing multifocal osteomyelitis (CRMO) is a rare condition. It commonly affects the clavicle and pelvis. Rarely it can affect the spine. Spinal deformity due to CRMO is rare. We report a case of acute scoliosis due to CRMO. A 10-year-old girl with CRMO presented with acute painful scoliosis of her spine. She was neurologically intact. Imaging suggested a neoplastic process involving T10, L2 and L3. Further imaging and subsequent biopsy was performed and a diagnosis of CRMO was established. Spinal involvement with deformity is uncommon. It is commonly misdiagnosed as infection or a neoplasm and unnecessary aggressive surgical and antibiotic therapy instituted. A high index of suspicion is needed to diagnose this disease and thus manage it appropriately. This patient with a previously normal spine had a long right sided thoracic scoliosis. We think that the particular pattern of scoliosis was a protective mechanism to offload the right sided T10 vertebral pedicle. Prognosis is generally good although the disease can relapse and remit over many years. At 9 months follow up, the lesions were resolving and the deformity had resolved. CRMO presenting as acute scoliosis is rare and to our knowledge this is the second recognised case in the reported world literature.
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Affiliation(s)
- Kedar Deogaonkar
- Trauma and Orthopaedics, University Hospital of Wales, Heath Park Avenue, Cardiff, CF14 4XW, UK.
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Kayani I, Kamani I, Syed I, Saifuddin A, Green R, MacSweeney F. Vertebral osteomyelitis without disc involvement. Clin Radiol 2004; 59:881-91. [PMID: 15451346 DOI: 10.1016/j.crad.2004.03.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Revised: 02/29/2004] [Accepted: 03/11/2004] [Indexed: 10/26/2022]
Abstract
Vertebral osteomyelitis is most commonly due to pyogenic or granulomatous infection and typically results in the combined involvement of the intervertebral disc and adjacent vertebral bodies. Non-infective causes include the related conditions of chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Occasionally, these conditions may present purely within the vertebral body, resulting in various combinations of vertebral marrow oedema and sclerosis, destructive lesions of the vertebral body and pathological vertebral collapse, thus mimicking neoplastic disease. This review illustrates the imaging features of vertebral osteomyelitis without disc involvement, with emphasis on magnetic resonance imaging (MRI) findings.
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Affiliation(s)
- I Kayani
- Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, UK
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Anderson SE, Heini P, Sauvain MJ, Stauffer E, Geiger L, Johnston JO, Roggo A, Kalbermatten D, Steinbach LS. Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement. Skeletal Radiol 2003; 32:328-36. [PMID: 12761599 DOI: 10.1007/s00256-002-0602-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2002] [Revised: 09/23/2002] [Accepted: 10/30/2002] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Initial presentation with primary spinal involvement in chronic recurrent multifocal osteomyelitis of childhood (CRMO) is rare. Our objective was to review the imaging appearances of three patients who had CRMO who initially presented with isolated primary spinal involvement. DESIGN AND PATIENTS The imaging, clinical, laboratory and histology findings of the three patients were retrospectively reviewed. Imaging included seven spinal MR imaging scans, one computed tomography scan, nine bone scans, two tomograms and 16 radiographs. These were reviewed by two musculoskeletal radiologists and a consensus view is reported. All three patients presented with atraumatic spinal pain and had extensive bone spinal pathology. The patients were aged 11, 13 and 12 years. There were two females and one male. RESULTS AND CONCLUSIONS The initial patient had thoracic T6 and T8 vertebra plana. Bone scan showed additional vertebral body involvement. Follow-up was available over a 3 year period. The second patient had partial collapse of T9 and, 2 years later, of C6. Subsequently extensive multifocal disease ensued and follow-up was available over 8 years. The third patient initially had L3 inferior partial collapse and 1 year later T8 involvement with multifocal disease. Follow-up was available over 3 years. The imaging findings of the three patients include partial and complete vertebra plana with a subchondral line adjacent to endplates associated with bone marrow MR signal alterations. Awareness of the imaging appearances may help the radiologist to include this entity in the differential diagnosis in children who present with spinal pathology and no history of trauma. Histopathological examination excludes tumor and infection but with typical imaging findings may not always be necessary.
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Affiliation(s)
- S E Anderson
- Department of Radiology, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland.
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Jurriaans E, Singh NP, Finlay K, Friedman L. Imaging of chronic recurrent multifocal osteomyelitis. Radiol Clin North Am 2001; 39:305-27. [PMID: 11316361 DOI: 10.1016/s0033-8389(05)70279-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The disease of CRMO is a "great clinical and radiologic mimic. There are no specific clinical or laboratory findings and no pathognomonic imaging or pathologic features have been described. Because the disease is not well known by clinician, radiologist, and pathologist alike, it is likely to be more common than the literature implies. It has been suggested that the diagnosis of CRMO requires an interdisciplinary team approach dependent on the cooperation of the pediatrician, orthopedic surgeon, pathologist, and microbiologist. We strongly advocate the addition of the radiologist to this list. We believe that it is the informed radiologist who frequently suggests the correct diagnosis.
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Affiliation(s)
- E Jurriaans
- Department of Radiology, McMaster University, St. Joseph's Hospital, Hamilton, Ontario, Canada.
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Bazrafshan A, Zanjani KS. Chronic recurrent multifocal osteomyelitis associated with ulcerative colitis: a case report. J Pediatr Surg 2000; 35:1520-2. [PMID: 11051168 DOI: 10.1053/jpsu.2000.16431] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease of bone first described by Giedion et al in 1972. It is associated with several pathologic processes including psoriasis, palmoplantar pustulosis, and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis). The only published association of CRMO and Crohn's disease was reported by Bognar et al in 1998. The authors describe the association of CRMO and ulcerative colitis (UC) in a 12-year-old girl. As far as the authors know, this is the first published report of CRMO associated with UC and the second of CRMO associated with inflammatory bowel diseases.
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Affiliation(s)
- A Bazrafshan
- Mashhad University of Medical Sciences, the Department of Pediatric Surgery, Dr Sheikh Children's Hospital, Mashhad, Iran
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Ruiz A, Donovan Post MJ, Sklar EM, Holz A. MR IMAGING OF INFECTIONS OF THE CERVICAL SPINE. Magn Reson Imaging Clin N Am 2000. [DOI: 10.1016/s1064-9689(21)00625-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schultz C, Holterhus PM, Seidel A, Jonas S, Barthel M, Kruse K, Bucsky P. Chronic recurrent multifocal osteomyelitis in children. Pediatr Infect Dis J 1999; 18:1008-13. [PMID: 10571440 DOI: 10.1097/00006454-199911000-00015] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Schultz
- Department of Pediatrics, Medical University of Lübeck, Germany.
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Tyrrell PN, Cassar-Pullicino VN, Eisenstein SM, Monach JF, Darby AJ, McCall IW. Back pain in childhood. Ann Rheum Dis 1996; 55:789-93. [PMID: 8976634 PMCID: PMC1010308 DOI: 10.1136/ard.55.11.789] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P N Tyrrell
- Institute of Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire, United Kingdom
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