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Chronic recurrent multifocal osteomyelitis, a rare disease. Case report
Osteomielitis multifocal recurrente crónica. Reporte de caso de una rara enfermedad
DOI:
https://doi.org/10.15446/cr.v8n1.91304Keywords:
Osteomyelitis, Cytokines, Osteitis (en)Osteomielitis, Citocinas, Osteítis (es)
Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disease usually observed in children and adolescents. It is caused by an imbalance between proinflammatory and anti-inflammatory factors. To establish its diagnosis, it is necessary to integrate clinical and laboratory elements that are typically aimed at ruling out other conditions, constituting a diagnosis of exclusion. Treatment is based on non-steroidal anti-inflammatory drugs and other drugs in specific cases.
Case presentation: A 16-year-old female patient with a 1-year history of joint pain, especially in the knees, accompanied by signs of local inflammation was admitted to the emergency department of a quaternary care hospital due to a fever >38.5°, odynophagia, asthenia, and adynamia over the last two days. The patient underwent multiple extension studies, including laboratory, imaging and histopathological tests, which ruled out various etiologic causes. She received empirical antibiotic treatment without remission of symptoms, so a diagnosis of CRMO was finally established and outpatient treatment with non-steroidal anti-inflammatory drugs and corticosteroids was indicated, obtaining a favorable response.
Conclusions: CRMO should be considered in children and adolescents with bone pain and a poorly defined clinical history with non-specific laboratory, imaging and histopathological findings. To date, little is known about CRMO, so it is necessary to carry out research and expand the knowledge related to this disease.
Introducción. La osteomielitis multifocal recurrente crónica (CRMO) es una enfermedad inflamatoria ósea poco frecuente que se presenta principalmente en niños y adolescentes a causa de un desequilibrio entre factores proinflamatorios y antiinflamatorios. Para establecer su diagnóstico se deben integrar elementos clínicos y paraclínicos con el fin de descartar otras entidades, pues su diagnóstico es de exclusión. El tratamiento se basa en antiinflamatorios no esteroideos y otros medicamentos en casos específicos.
Presentación del caso. Adolescente femenina de 16 años con cuadro clínico de un año de evolución consistente en episodios de dolor articular, especialmente en rodillas, acompañado de signos de inflamación local, quien ingresó al servicio de urgencias de un hospital de cuarto nivel por presentar fiebre >38.5°, odinofagia, astenia y adinamia durante los dos últimos días. A la paciente se le realizaron múltiples estudios de extensión, incluyendo exámenes de laboratorio, imagenológicos e histopatológicos, con los que se descartaron diversas causas etiológicas. Asimismo, la joven recibió tratamiento antibiótico empírico sin remisión de sus síntomas, por lo que finalmente se estableció el diagnóstico de CRMO y se indicó manejo ambulatorio con antiinflamatorios no esteroideos y corticoesteroides, con el cual se obtuvo respuesta favorable.
Conclusiones. La CRMO debe ser considerada en niños y adolescentes con dolor óseo y un cuadro clínico poco definido con hallazgos de laboratorio, imagenológicos e histopatológicos inespecíficos. En la actualidad es poco lo que se conoce sobre la CRMO, por lo que es necesario realizar investigaciones y ampliar los conocimientos relacionados con esta enfermedad.
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