[Chronic recurrent multifocal osteomyelitis in a pediatric patient, a case report]. / Osteomielitis crónica multifocal recurrente en paciente pediátrico, reporte de caso.

INTRODUCTION: Chronic recurrent multifocal osteomyelitis (CRMO) is a very rare disease, of unknown origin that affects primarily the metaphysis of long bones. It is characterized by an insidious onset of symptoms and multiple remissions. The chronicity of symptoms, the diagnostic imaging and the lack of response to first line antibiotic treatment, should be helpful for diagnostic. OBJECTIVE: Present a clinical case, based on clinical, laboratory, radiologic imaging and histopathological results, that ultimately led to the diagnostic of CRMO. CASE REPORT: 9 year old, female patient, with one month of bilateral knee and left ankle arthralgia. Bone Gammagraphy and full body MRI, showed multifocal bone inflammation. These findings led to a biopsy, that turned negative for malignancy and infection. Given all the information available from the laboratory test results, radiologic imaging and histopathological findings, CRMO diagnosis was made. NSAID treatment was order, with good results. CONCLUSIONS: CRMO is a rare disease that even to date and with cutting edge technology, still represents a diagnostic challenge that primarily relies on a high level of suspicion, for a timely and correct treatment.

Osteomielitis crónica multifocal recurrente en paciente pediátrico, reporte de caso / Chronic recurrent multifocal osteomyelitis in a pediatric patient, a case report

Introducción: La osteomielitis crónica multifocal recurrente (OCMR) es una enfermedad rara de causa desconocida, que afecta principalmente la metáfisis de los huesos largos; se caracteriza por un cuadro clínico insidioso de exacerbaciones y remisiones; la cronicidad de los síntomas, los hallazgos imagenológicos y la falta de respuesta al manejo con antibióticos, orientan al diagnóstico. Objetivo: Presentar los datos clínicos, resultados de laboratorio, imagenológicos y estudios histo- patológicos que permiten realizar el diagnóstico de OCMR. Caso clínico: Paciente de sexo femenino de 9 años, con artralgias en ambas rodillas y tobillo izquierdo de 1 mes de duración. Los estudios de gammagrafía ósea y resonancia corporal total evidenciaron compromiso óseo multifocal; con estos hallazgos, se realizó biopsia que fue negativa para infección y malignidad. Por la evolución, estudios de laboratorio, radiológicos e histo-patológicos se diagnosticó OCMR. Se inició tratamiento con anti-inflamatorios no esteroides con adecuada respuesta. Conclusiones: La OCMR es una patología poco frecuente de difícil diagnóstico, por lo que se requiere de una alta sospecha clínica para realizar un adecuado enfoque y tratamiento oportuno.

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a very rare disease, of unknown origin that affects primarily the metaphysis of long bones. It is characterized by an insidious onset of symptoms and multiple remissions. The chronicity of symptoms, the diagnostic imaging and the lack of response to first line antibiotic treatment, should be helpful for diagnostic. Objective: Present a clinical case, based on clinical, laboratory, radiologic imaging and histopathological results, that ultimately led to the diagnostic of CRMO. Case report: 9 year old, female patient, with one month of bilateral knee and left ankle arthralgia. Bone Gammagraphy and full body MRI, showed multifocal bone inflammation. These findings led to a biopsy, that turned negative for malignancy and infection. Given all the information available from the laboratory test results, radiologic imaging and histopathological findings, CRMO diagnosis was made. NSAID treatment was order, with good results. Conclusions: CRMO is a rare disease that even to date and with cutting edge technology, still represents a diagnostic challenge that primarily relies on a high level of suspicion, for a timely and correct treatment.