Girschick H J, Huppertz H I, Harmsen D, Krauspe R, Müller-Hermelink H K, Papadopoulos T
Universitäts-Kinderklinik und Poliklinik, the Institut für Hygiene und Mikrobiologie, Universität Würzburg, Germany.
Hum Pathol. 1999 Jan;30(1):59-65. doi: 10.1016/s0046-8177(99)90301-5.
Chronic recurrent, unifocal or multifocal osteomyelitis (CRMO), an inflammatory disorder of unknown origin, involves different osseous sites and may be associated with palmoplantar pustulosis. Bacterial cultures of affected tissue were reported negative in nearly all cases. Radiological and magnetic resonance imaging features of CRMO have been described, but differential diagnosis remains difficult, including rheumatic diseases, bacterial osteomyelitis, and malignancy. Although definite diagnosis relies on histopathologic confirmation by biopsy, histopathologic criteria have not been defined. Because CRMO may be treated with nonsteroidal antiinflammatory drugs, but not antibiotics, distinguishing CRMO from bacterial osteomyelitis is of major importance. Histopathologic analysis of 12 patients with CRMO indicated a wide variation of reparative changes of bone, but chronic inflammation could not be found at all sites in the same biopsy. The inflammatory infiltrate was mostly scattered, consisting mainly of lymphocytes, plasma cells, histiocytes, and also few neutrophil granulocytes. Immunohistochemistry showed a predominance of CD3(+), CD45RO(+) T-cells, which were mainly CD8(+). In addition, CD20(+) B cells and CD68(+) macrophages were abundant in each biopsy specimen. Mild lymphocytic and granulocytic infiltrates were also detected in three synovial biopsy specimens obtained from adjacent joints. All bacterial and fungal cultures from native biopsy tissues were negative. Amplification of partial-length 16S ribosomal DNA by polymerase chain reaction (PCR) using broad-range eubacterial primers was below the detection limit in all patients. Because histopathologic features alone may not provide conclusive evidence, CRMO should be included in the differential diagnosis of chronic inflammatory bone lesions in children, and the definite diagnosis should be made by the clinical picture, x-ray studies, bone scan, bacterial culture, and histopathologic analysis in a multidisciplinary approach.
慢性复发性单灶性或多灶性骨髓炎（CRMO）是一种病因不明的炎症性疾病，累及不同骨部位，可能与掌跖脓疱病相关。几乎所有病例中受累组织的细菌培养结果均为阴性。CRMO的放射学和磁共振成像特征已有描述，但鉴别诊断仍很困难，包括风湿性疾病、细菌性骨髓炎和恶性肿瘤。虽然明确诊断依赖于活检的组织病理学证实，但组织病理学标准尚未明确。对12例CRMO患者的组织病理学分析表明，骨修复性改变差异很大，但在同一次活检的所有部位均未发现慢性炎症。炎症浸润大多散在分布，主要由淋巴细胞、浆细胞、组织细胞组成，也有少量中性粒细胞。免疫组化显示CD3(+)、CD45RO(+) T细胞占优势，主要为CD8(+)。此外，每个活检标本中CD20(+) B细胞和CD68(+)巨噬细胞丰富。从相邻关节获取的3个滑膜活检标本中也检测到轻度淋巴细胞和粒细胞浸润。取自活检组织的所有细菌和真菌培养均为阴性。使用通用细菌引物通过聚合酶链反应（PCR）扩增全长16S核糖体DNA，在所有患者中均低于检测限。由于仅组织病理学特征可能无法提供确凿证据，CRMO应纳入儿童慢性炎症性骨病变的鉴别诊断中，明确诊断应通过临床症状、X线检查、骨扫描、细菌培养和组织病理学分析的多学科方法来做出。
