Bone pain, low grade fever and elevated INFLAMMATORY MARKERS: KEEP IN MIND ALSO CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS

Key words: Chronic recurrent multifocal osteomyelitis, Bone pain, Fever, Children

The paper reports the case of a 7-year-old child who presented with recurrent multifocal bone pain associated with low fever, elevation of flogosis indexes and negative standard radiological exams. The spectrum of differential diagnosis was wide. The magnetic resonance imaging (MRI) scan of his right knee and elbow revealed a multifocal areas of oedema-like bone marrow signal (abnormal hyperintensity on STIR images and abnormal hypointensity on T1-weighthed images). The main differential was exclusion of infection and malignancy. Bone marrow aspirate and biopsy was normal. Cultures from blood and bone biopsies were also negative. Bone biopsy was required and it showed chronic, non specific, aseptic inflammation. After ruling out acute or chronic infectious, malignancies, and benign bone tumors the final diagnosis was of chronic recurrent multifocal osteomyelitis (CRMO). The case highlights the importance of thinking about chronic nonbacterial osteomyelitis when a patient presents with recurrent episodes of unifocal or multifocal bone pain associated with fever.