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PEDIATRICS Vol. 113 No. 4 April 2004, pp. e380-e384

ELECTRONIC ARTICLE

Chronic Recurrent Multifocal Osteomyelitis of the Spine and Mandible: Case Report and Review of the Literature

Colleen S. Y. Chun, MD

From the Department of Pediatrics, Northwest Permanente, Portland, Oregon

At initial presentation, chronic recurrent multifocal osteomyelitis may mimic acute hematogenous osteomyelitis; however, cultures of affected bone are sterile. Nuclear scintigraphy identifies additional foci of involvement that present concurrently or sequentially. Unlike acute bacterial osteomyelitis, chronic recurrent multifocal osteomyelitis seems unaffected by antibiotic therapy and typically responds to treatment with antiinflammatory drugs. Surgical decortication has been reported for refractory cases. The case presented here illustrates the rare involvement of the mandible after initial presentation in the spine of a 4-year-old girl and the refractory nature of the disease over 6 years despite treatment with various medical and surgical therapies.

Key Words: bone diseases • osteitis • hyperostosis

Abbreviations: CRMO, chronic recurrent multifocal osteomyelitis • MRI, magnetic resonance imaging • ESR, erythrocyte sedimentation rate • CT, computed tomography • AFB, acid-fast bacilli • Ig, immunoglobulin • PCR, polymerase chain reaction • DSO, diffuse sclerosing osteomyelitis • SAPHO, synovitis, acne, palmoplantar pustulosis, hyperostosis, osteitis syndrome

Received for publication Sep 15, 2003; Accepted Nov 24, 2003.