Hu Minhua, Zeng Wenxing, Zhang Jingtao, Yan Hongsong, Huang Feng, Xiong Hao, Fang Bin, Li Yue
Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, China.
Guangzhou University of Chinese Medicine, Guangzhou, China.
Medicine (Baltimore). 2024 Dec 6;103(49):e40805. doi: 10.1097/MD.0000000000040805.
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disorder that commonly poses diagnostic challenges due to its atypical symptomatology. This observational study aimed to investigate the clinical features, laboratory test results, imaging features, and treatment strategies for pediatric patients with CRMO. We retrospectively analyzed 7 pediatric patients with CRMO treated at the Department of Pediatric Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2018 and February 2022. This study aimed to enhance current understanding of CRMO by exploring in-depth clinical data. The study cohort comprised 5 males and 2 females, aged 3 to 13 years. All patients experienced symptoms for a median duration of 6 months prior to hospitalization, at which point they presented with recurrent pain and various accompanying signs including hypothermia (14.28%), swelling (42.85%), localized skin warmth (42.85%), and plantar pustules (14.28%). The femurs (71.42%) and tibia (71.42%) were frequently affected. Radiographic and computed tomography scans revealed osteosclerosis and osteolytic lesions, while magnetic resonance imaging revealed bone marrow edema. Histological examination of bone biopsies from 4 patients revealed fibrous tissue hyperplasia and lymphocytic and neutrophilic infiltration, despite negative bacterial cultures. Laboratory test results were either normal or slightly elevated. Symptomatic improvement was observed in 6 patients (85.72%) treated with nonsteroidal anti-inflammatory drugs, while 1 patient (14.28%) resistant to nonsteroidal anti-inflammatory drugs responded well to tumor necrosis factor inhibitors. The clinical presentation of CRMO lacks specificity, with unexplained bone pain being the most common symptom. Precise diagnosis and timely intervention depend on a thorough magnetic resonance imaging evaluation for lesion detection, which facilitates CRMO diagnosis. This study offers valuable insights into the clinical manifestations, laboratory findings, imaging features, and treatment strategies of CRMO in pediatric patients.
慢性复发性多灶性骨髓炎（CRMO）是一种罕见的自身炎症性疾病，因其非典型症状常给诊断带来挑战。本观察性研究旨在调查儿童CRMO患者的临床特征、实验室检查结果、影像学特征及治疗策略。我们回顾性分析了2018年1月至2022年2月期间在广州中医药大学第一附属医院小儿骨科接受治疗的7例儿童CRMO患者。本研究旨在通过深入探究临床数据来增进对CRMO的当前认识。研究队列包括5名男性和2名女性，年龄在3至13岁之间。所有患者在住院前症状持续的中位时间为6个月，此时他们表现为反复疼痛及各种伴随体征，包括体温过低（14.28%）、肿胀（42.85%）、局部皮肤发热（42.85%）和足底脓疱（14.28%）。股骨（71.42%）和胫骨（71.42%）是常受累部位。X线和计算机断层扫描显示骨质硬化和溶骨性病变，而磁共振成像显示骨髓水肿。4例患者的骨活检组织学检查显示纤维组织增生以及淋巴细胞和中性粒细胞浸润，尽管细菌培养结果为阴性。实验室检查结果正常或略有升高。6例（85.72%）接受非甾体抗炎药治疗的患者症状有所改善，而1例对非甾体抗炎药耐药的患者（14.28%）对肿瘤坏死因子抑制剂反应良好。CRMO的临床表现缺乏特异性，不明原因的骨痛是最常见症状。准确诊断和及时干预取决于对病变检测进行全面的磁共振成像评估，这有助于CRMO的诊断。本研究为儿童CRMO的临床表现、实验室检查结果、影像学特征及治疗策略提供了有价值的见解。
