Chronic Recurrent Multifocal Osteomyelitis with an uncommon presentation and disabling features: A case report

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is one of the auto-inflammatory bone disorders with yet to be determined etiology. Due to overlapping signs and symptoms with other bone involvements, the diagnosis of this disease might take a long period of time and the patients may develop deformities in long-term. Thus, increasing awareness about different presentations of the disease seems beneficial.Case presentation: A 12-year-old boy was referred to our center with severe back pain in his thoracic vertebrae from 18 months before referral. He had previously undergone two vertebroplasty surgeries due to his kyphosis and had received several courses of antibiotics, which resulted in no improvement in his disabling pain. His physical examination was unremarkable, except for severe thoracic vertebrae tenderness and a mild dextroscoliosis. MRI showed diffuse multiple hypo-signal lesions in thoracic vertebral bodies with slight enhancement, causing compression fractures of T8, T11 and T12 bodies. Bone scan revealed increased activity in thoracic region (T7-T8-T9-T12 vertebral bodies) and left clavicle. Other differentials were ruled out by bone marrow aspiration, bone biopsy and laboratory tests. His disease showed a favorable response to treatment with Pamidronate, Methotrexate and Indomethacin and he had no relapse in three years of follow-up.Conclusions: Uncommon presentations of CRMO can be misleading to the specialists and might result in prolonged diagnosis process. Increased awareness among different specialists about such presentations can potentially lead to earlier diagnosis, and timelier and more effective treatment of the CRMO patients.