Naslov
Diagnostic and therapeutic approach to a child with chronic recurrent multifocal osteomyelitis (CRMO)

Autori
2. Prohić, Avdo, Tambić Bukovac, Lana, Jelušić, Marija, Đapić, T, Potočki, K, Malčić, Ivan

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Europaediatrics 2003, book of abstracts / - , 2003

Skup
Europaediatrics 2003

Mjesto i datum
Prag, Češka Republika, 2003

Vrsta sudjelovanja
Ostalo

Vrsta recenzije
Domaća recenzija

Ključne riječi
Chronic recurrent multifocal osteomyelitis; therapeutic approach

Sažetak
Chronic recurrent multifocal osteomyelitis (CRMO), first described by Giedion in 1972, is the disease of unknown etiology with clinicaly features similiar to those of septic osteomyelitis. It is characterised by multifocal bone pain, often accompanied by fever. We present two patients who meet the criteria for CRMO. The first patient is a 4-year old girl who was admitted to our hospital after bone biopsy, which showed chronic reactive inflammatory changes in distal tibia. First symptoms appeared four months before hospitalisation with impaired walking, pain in distal part of right tibia and methatarsal bones, followed by swelling. She also had recurrent fever. Bone scintigraphy revealed multifocal increased radionuclide uptake (right mandibule, distal part of right tibia and right methatarsus). Radiographs showed lytic lesions of distal tibia and third methatarsal bone. All bacteriological specimens were negative. She was treated with wide-spectrum antibiotics, but unsuccessfully. After we established the diagnosis of CRMO, the therapy with NSAIDs and azithromycin (because of its anti-inflammatory effect) was introduced. After two months the patient was painless, walked normally and radiographs showed improvement with regression of osteolytic lesions. The second patient is a 3-year old girl who initially was admitted to Department of Paediatric Neurology because she was suspected to have neuromuscular disorder. First symptoms were present two years ago, when she started walking. She had muscle weakness and often cried painfully. In the last several months she refused to walk, her arms and legs were swollen, she avoided manipulation and had periodic fever. Bone scintigraphy and radiographs showed multifocal osteolytic lesions (vertebra, ribbs, clavicles, long bones of both arms and legs). Neurological disfunction appeared probably as the result of changes in the spine. EMNG revealed myopathic pattern in distal muscles, and severe chronic neurogenic lesion in proximal muscles. When the diagnosis of CRMO was established, NSAIDs were introduced in the therapy and certain clinical improvement was noticed, but as the process was so widely spread we decided to give glucocorticoids. After one month of this therapy the child started walking, she had no pains, and radiographs showed improvement of osteolytic lesions, but not complete regression. Conclusion: CRMO is not an infective disease, so antibiotic therapy is unnecessary. The cause is still unknown. Good response to NSAID and steroid therapy suggests that autoimmune process might play the major role in the pathogenesis of CRMO

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA