Abstract
Background
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory disorder that often pose diagnostic challenges due to its atypical symptomatology. This retrospective study aimed to investigate the clinical features, laboratory tests, imaging features, and treatment strategies of CRMO in pediatric patients.
Methods
In the study, seven 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, were retrospectively analyzed. The objective was to enhance understanding of CRMO by exploring clinical data in-depth.
Results
The study group comprised five males and two females, aged 3 to 13 years. They experienced symptoms for a median duration of 6 months before hospitalization, presenting with recurrent pain and various accompanying signs, including hypothermia (one case, 14.28%), swelling (three cases, 42.85%), localized skin warmth (three cases, 42.85%), and plantar pustules (one case, 14.28%). The femur (five cases,71.42%) and tibia (five cases, 71.42%) were frequently affected. Radiographic and CT scans showed osteosclerosis and osteolytic lesions, while MRI detected bone marrow edema. Histological examination of bone biopsies from four patients revealed fibrous tissue hyperplasia, lymphocytic, and neutrophilic infiltration, despite negative bacterial cultures. Laboratory tests generally showed normal or slightly elevated values. Symptomatic improvement was observed in six patients (85.72%) with nonsteroidal anti-inflammatory drugs (NSAIDs), while one patient (14.28%) resistant to NSAIDs responded well to tumor necrosis factor (TNF) inhibitors.
Conclusions
In summary, CRMO's clinical presentation lacks specificity, with unexplained bone pain being the most common symptom. Precise diagnosis and timely intervention depend on thorough MRI evaluation for lesion detection, enhancing CRMO diagnosis. This study offers valuable insights into CRMO's clinical manifestations, laboratory findings, imaging features, and treatment strategies in pediatric patients.