Department of Woman and Child and General and Specialized Surgery, University of the Study of Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, 80138, Naples, Italy.
Ital J Pediatr. 2018 Feb 17;44(1):26. doi: 10.1186/s13052-018-0463-3.
Chronic recurrent multifocal osteomyelitis (CRMO), also known as chronic nonbacterial osteomyelitis, is a rare, noninfectious inflammatory disorder that causes multifocal bone lesions with swelling and pain. Lytic and sclerotic bone lesions could be found on X-ray. Short tau inversion recovery magnetic resonance imaging (STIR MRI) shows bone marrow oedema, bone expansion, lytic areas and periosteal reaction. CRMO is characterized by periodic exacerbations and remissions of unclear/unknown pathogenesis.
A 10 years old girl, suffering from pain in her right shoulder since the age of 9 years presented to our Department. Thanks to clinical data, laboratoristic and radiological findings and bone biopsy CRMO was diagnosed. So patient started anti-inflammatory treatment and her conditions improved.
In a child with bone pain should be considered also rare condition as CRMO to perform a correct diagnosis and start an adequate treatment avoiding complications such as bone damage. This condition should be suspected in a child with recurrent bone pain, modest increase of inflammatory indices, lytic or sclerotic bone lesion on X Ray. Typical CRMO localizations are metaphyses of long bones, pelvis, clavicle, vertebral column, sternum, ribs, jaw, but any bone can be involved. The most common CRMO differential diagnosis is represented by infections, malignant bone tumors, Langerhans Cells Histiocytosis (LCH).
慢性复发性多灶性骨髓炎（CRMO），也称为慢性非细菌性骨髓炎，是一种罕见的、非传染性的炎症性疾病，导致多灶性骨病变伴肿胀和疼痛。X 射线可发现溶骨性和硬化性骨病变。短 tau 反转恢复磁共振成像（STIR MRI）显示骨髓水肿、骨扩张、溶骨区和骨膜反应。CRMO 的特点是病因不明/未知的周期性加重和缓解。
一名 10 岁女孩，9 岁时出现右肩部疼痛，到我科就诊。根据临床资料、实验室和影像学检查及骨活检，诊断为 CRMO。因此，患者开始接受抗炎治疗，病情好转。
对于有骨痛的儿童，即使是罕见的 CRMO 也应考虑在内，以便做出正确的诊断并开始进行适当的治疗，避免出现骨损伤等并发症。这种情况应怀疑为儿童复发性骨痛、炎症指标适度升高、X 射线显示溶骨性或硬化性骨病变。典型的 CRMO 定位是长骨、骨盆、锁骨、脊柱、胸骨、肋骨、颌骨的干骺端，但任何骨骼都可能受累。CRMO 最常见的鉴别诊断是感染、恶性骨肿瘤、朗格汉斯细胞组织细胞增生症（LCH）。
