Chronic recurrent multifocal and aspecific osteomyelitis: a case report

Abstract

Chronic recurrent multifocal and unspecific osteomyelitis (CRMUO) is a severe form of chronic nonbacterial osteomyelitis. Lesions can be found anywhere in the skeleton, in young patients, such as children or adolescents, chronic nonbacterial osteomyelitis often affects the metaphyses of the long bones. Furthermore, other organs like skin, eyes and gastrointestinal tract can also be affected. Because of symptoms and course of disease vary in significant way, a clinical diagnosis is often difficult. The radiographic appearance suggests subacute or chronic osteomyelitis. CRMUO may mimic acute hematogenous osteomyelitis, but bacterial culture are usually negative and nonspecific histopathological and laboratory findings are present. This kind of osteomyelitis is often diagnosed by exclusion of the two main differential diagnoses-bacterial infections and tumor-by assessing for a characteristic course and the findings by conventional radiography, if necessary supplemented by scintigraphy and magnetic resonance imaging (MRI). The MRI appearance of CRMUO lesions in tubular bones and the spine is often rather characteristic and can support the diagnosis. It is important to diagnose CRMUO to avoid unnecessary diagnostic procedures or therapy, and initiate an appropriate one. We present a case report of a 44-year-old woman diagnosed with CRMUO involving both femurs.