scholarly journals Clinical and Diagnostic Considerations for Atypical, Adult Onset Presentation of Chronic Recurrent Multifocal Osteomyelitis (CRMO)

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Stacey Mahady ◽  
Amit Ladani
Keyword(s):  
Bone Biopsy ◽  
Delayed Diagnosis ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
The Elderly ◽  
Severe Form ◽  
X Rays ◽  
Elderly Age ◽  
Bony Lesions ◽  
Multifocal Osteomyelitis ◽  
One Year

Chronic recurrent multifocal osteomyelitis (CRMO) is the most severe form of chronic nonbacterial osteomyelitis (CNO) and is a rare autoinflammatory bone disorder that mostly affects children and adolescents. CRMO is a diagnosis of exclusion, resulting in often-delayed diagnosis with over one year on average from onset of symptoms to time of diagnosis. Initial diagnosis is rare in adults and previously undocumented in the elderly (age greater than 65). We highlight a case of a 74-year-old elderly Caucasian female with a history of palmoplantar pustular psoriasis who presented with pelvic and hip pain. Imaging findings included multiple bony lesions on x-rays, increased uptake in the left side of the pelvis, ileum, proximal sternum, and bilateral medial clavicles on nuclear bone scan. Bone biopsy histologic results of marrow fibrosis and plasma cell infiltrate indicative of chronic inflammation lead to the diagnosis of CRMO. This case highlights that while CRMO is typically a disease with childhood onset, it, while rare, can also present in adults and now has presented in the elderly, remaining an important part of the differential diagnosis of bone pain in adults and the elderly in addition to infectious osteomyelitis and malignancy when imaging reveals multiple bony lesions. This in turn will facilitate the reduction of unnecessary medical treatment and antibiotics.

Chronic Recurrent Multifocal Osteomyelitis in Children

1988 ◽  
Vol 29 (5) ◽  
pp. 565-570 ◽  
Author(s):  
W. Mortensson ◽  
G. Edeburn ◽  
M. Fries ◽  
R. Nilsson
Keyword(s):  
Bone Scintigraphy ◽  
Bone Biopsy ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Conventional Radiography ◽  
Radiographic Appearance ◽  
Radiologic Evaluation ◽  
Biopsy Specimens ◽  
Multifocal Osteomyelitis ◽  
Vertebral Bodies ◽  
Bacteria And Fungi

Thirty cases of chronic recurrent multifocal osteomyelitis have been reported in the literature. A radiologic evaluation of thirty-one additional cases, 25 of whom also underwent bone scintigraphy, is presented. Bone biopsy specimens were obtained in 16 patients. Most lesions were located in the metaphyses of the long bones adjacent to the physis and had a characteristic, probably pathognomonic appearance. Extension into the epiphyses was rare. Lesions in the vertebral bodies, clavicle and pelvis had possibly a less specific radiographic appearance. Lesions in short tubular bones were non-specific. Bone scintigraphy had a pratical value in evaluating the global distribution of lesions including asymptomatic lesions and lesions in the spine or pelvis, the latter being somewhat hard to detect with conventional radiography. All biopsies showed acute, subacute or chronic unspecific osteomyelitis, sometimes mixed in the same lesion. Staining for bacteria and fungi was negative.

scholarly journals Chronic Recurrent Multifocal Osteomyelitis Causing an Acute Scoliosis

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Alexander Armstrong ◽  
Neil Upadhyay ◽  
Edward Saxby ◽  
Damian Pryce ◽  
Nick Steele
Keyword(s):  
Bone Biopsy ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Shoulder Girdle ◽  
Symptomatic Management ◽  
Mri Scans ◽  
History Of ◽  
Multifocal Osteomyelitis ◽  
Atypical Presentations ◽  
Whole Spine ◽  
Bone Condition

Study Design. A Case Report.Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO).Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine.Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR) sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved.Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding.Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.

scholarly journals Update: Cytokine Dysregulation in Chronic Nonbacterial Osteomyelitis (CNO)

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sigrun R. Hofmann ◽  
Angela Roesen-Wolff ◽  
Gabriele Hahn ◽  
Christian M. Hedrich
Keyword(s):  
Musculoskeletal System ◽  
High Titer ◽  
Unknown Origin ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Severe Form ◽  
Autoinflammatory Disorder ◽  
Clinical Criteria ◽  
Multifocal Osteomyelitis ◽  
Cytokine Dysregulation ◽  
Chronic Nonbacterial Osteomyelitis

Chronic nonbacterial osteomyelitis (CNO) with its most severe form chronic recurrent multifocal osteomyelitis (CRMO) is a non-bacterial osteitis of yet unknown origin. Secondary to the absence of both high-titer autoantibodies and autoreactive T lymphocytes, and the association with other autoimmune diseases, it was recently reclassified as an autoinflammatory disorder of the musculoskeletal system. Since its etiology is largely unknown, the diagnosis is based on clinical criteria, and treatment is empiric and not always successful. In this paper, we summarize recent advances in the understanding of possible etiopathogenetic mechanisms in CNO.

THE "SAPHO" SYNDROME: A CASE REPORT OF A PATIENT WITH AN ACCIDENTAL FINDING OF HYPEROSTOSIS IN PLAIN X-RAYS OF THORAX

2008 ◽  
Vol 11 (01) ◽  
pp. 29-35
Author(s):  
M. Pyrgioti ◽  
E. Mahaira ◽  
G. Papagiannakis ◽  
A. Syrou ◽  
I. H. Alexandris ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Health Status ◽  
Bone Tissue ◽  
Laboratory Tests ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Sapho Syndrome ◽  
X Rays ◽  
Multifocal Osteomyelitis ◽  
Histopathologic Findings

The authors describe the clinical, bone scintigraphy, and histopathologic findings of chronic recurrent multifocal osteomyelitis (CRMO), which is considered to be part of the SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Knowledge of this disorder may help in the differential diagnosis of arthritis, and it will help avoid repeated biopsies. We report the case of a 52-year-old man who was admitted to hospital due to an accidental finding in plain X-rays during his first check-up of his health status. He underwent laboratory tests, imaging examinations, and biopsy and histopathologic examinations of bone tissue; and was diagnosed with the SAPHO syndrome (CRMO).

scholarly journals Bilateral Antro-Choanal Polyps in an Elderly Female

2011 ◽  
Vol 26 (2) ◽  
pp. 28-30
Author(s):  
Indranil Sen ◽  
Ankur Mukherjee ◽  
Jayanta Saha ◽  
Satadal Mandal ◽  
Ramanuj Sinha
Keyword(s):  
The Elderly ◽  
Sinus Surgery ◽  
Age Group ◽  
Government Hospital ◽  
Elderly Age ◽  
Elderly Female ◽  
First Case ◽  
Choanal Polyp ◽  
One Year

Objective: To report the first case of primary bilateral antro-choanal polyps in the elderly age group.   Methods:        Design: Case Report        Setting: Tertiary Government Hospital        Patient: One   Result: A 60-year-old, non-allergic female with progressive bilateral nasal obstruction was subsequently diagnosed with bilateral antro-choanal polyps. Endoscopic sinus surgery was performed and the patient remained asymptomatic on one year follow-up.   Conclusion: Antro-choanal polyps can occur bilaterally in the elderly age group. To the best of our knowledge, this is the first reported case of primary bilateral antro-choanal polyps in an elderly female.   Keywords: antro-choanal polyp; bilateral; elderly; female  

Radiographic changes of chronic recurrent multifocal osteomyelitis that persisted into adulthood

2020 ◽  
Vol 13 (7) ◽  
pp. e232106
Author(s):  
Andrew Bergeron ◽  
Thomas Lewellen ◽  
Bhavesh Joshi
Keyword(s):  
Inflammatory Markers ◽  
Proximal Tibia ◽  
Bone Biopsy ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Radiographic Imaging ◽  
Anterior Cortex ◽  
Osteolytic Lesions ◽  
Reactive Protein ◽  
Multifocal Osteomyelitis ◽  
Radiographic Changes

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare non-infectious autoinflammatory disorder typically seen in young women. We describe the case of a young man who presented at 13 years of age with pain in the tibia, humerus, clavicle and hip. Worsening of the condition through clinical presentation and radiographic imaging was observed over 10 years. Radiographic imaging initially showed some sclerotic changes, but worsened to osteolytic lesions of the proximal tibia, elevation of the lateral cortex and thickening of the anterior cortex. Bone biopsy of his right anterior proximal tibia showed no infection or neoplasia. But, laboratory results showed elevation of inflammatory markers such as erythrocyte sedimentation rate or C-reactive protein. The patient was diagnosed with CRMO and treated with antibiotics for suspicion of chronic bacterial osteomyelitis. Chronic bone pain, abnormal imaging and elevation of inflammatory markers suggesting that chronic bacterial osteomyelitis can lead to difficulties with the diagnosis of CRMO.

scholarly journals Subacute physeal abscess: case report to illustrate treatment with a minimally invasive incision and drainage technique

2012 ◽  
Vol 94 (2) ◽  
pp. e51-e54 ◽  
Author(s):  
TT Shah ◽  
KF Chin ◽  
A Noorani ◽  
D Nairn
Keyword(s):  
Minimally Invasive ◽  
Delayed Diagnosis ◽  
Suction Catheter ◽  
Low Grade ◽  
X Rays ◽  
Local Policy ◽  
Leg Length ◽  
Brodie’S Abscess ◽  
One Year ◽  
The Right

Introduction Brodie’s abscess is a form of subacute osteomyelitis characterised by a low grade pyogenic abscess found most commonly in the metaphysis. One rare form found in children crosses the physeal growth plate and into the epiphysis. Due to the rarity of this subtype and apprehension associated with treatment of the transphyseal abscess, no clear guidance exists on its management. Case History We present a case of delayed diagnosis of Brodie’s abscess crossing the physis in a 14-year-old boy. He gave a one-year history of pain in the right knee and early x-rays had shown lucent areas in the tibia. However, these were only noted to be significant at presentation one year later. We also describe an improvised minimally invasive and atraumatic technique of modifying a laminar suction catheter for accessing and draining the abscess. Conclusions From our experience and reports in the literature it is clear that antibiotic treatment is generally advocated with varying degrees of surgical intervention. Outcomes are largely favourable. Nevertheless, initial drainage allows samples to be sent for microbiological and histological assessment to aid subsequent management and may prevent subsequent leg length discrepancy from failed conservative treatment. We believe that management of a transphyseal abscess must include early drainage and a prolonged course of antibiotics. The antibiotic choice and duration will be governed by culture results and local policy but is commonly given for up to six weeks in the literature and must include one antistaphylococcal drug.

scholarly journals Chronic recurrent multifocal osteomyelitis in a 9 year old girl: A Case Report

2018 ◽  
Vol 5 (2) ◽  
pp. 51-55
Author(s):  
Samaj Gautam ◽  
Nabees Pradhan ◽  
Bidur Gyawali
Keyword(s):  
Bone Pain ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
The Body ◽  
Leg Pain ◽  
Bone Lesions ◽  
Medical Sciences ◽  
Medical College ◽  
Bony Lesions ◽  
Multifocal Osteomyelitis ◽  
Bony Lesion

Background and Objectives: Chronic recurrent mutlifocal osteomyelitis (CRMO) is an extremely rare skeletal disorder in the younger population. It presents with multifocal bony lesions that often mimic more sinister diagnoses such as neoplasm. The cause of this condition remains unknown and there is limited evidence on effective treatment.Presentation of Case: A 9-year-old girl presented to our institution with non-traumatic onset of left leg pain. After failed conservative management, radiographs and MRI were obtained exhibiting a bony lesion of the proximal tibia resembling osteomyelitis. The patient was non-responsive to antibiotics, so corticotomy and drainage was done in which only blood came out of the lesion, no pus was seen. Patient improved dramatically but again she developed similar symptoms and signs on right leg. Biopsy from left leg suggested no significant findings.Discussion: Chronic recurrent multifocal osteomyelitis presents in patients with periodic fevers, bone pain and bone lesions that can develop anywhere in the body. This is a rare disease, which has been found to affect more girls than boys.Conclusion: CRMO should be considered as a differential diagnosis for chronic bone pain with affinity for the long bones of the lower extremity in children and adolescents. Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(2): 51-55 

scholarly journals Chronic Recurrent Multifocal Osteomyelitis with Concomitant Features of Juvenile Idiopathic Arthritis

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Elena Tsitsami ◽  
Vasiliki Dermentzoglou ◽  
Mary Moschovi ◽  
George P. Chrousos
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Middle Finger ◽  
Proximal Interphalangeal Joint ◽  
Joint Effusion ◽  
Bone Lesions ◽  
Severe Arthritis ◽  
Significant Amelioration ◽  
Multifocal Osteomyelitis ◽  
One Year

We report a case of a 13-year-old girl with chronic recurrent multifocal osteomyelitis (CRMO) who developed severe arthritis in four different joints within the first year from the onset of the disease. Her multiple vertebrae lesions showed significant amelioration after a 2-month treatment with prednisolone. In parallel, the initial severe symmetrical arthritis of both knees showing overt synovitis and joint effusion, in the absence of lesions in the metaphyses of the femur or the tibia, responded remarkably well in intra-articular triamcinolone hexacetonide injections. However, upon discontinuation of prednisolone, the patient developed severe arthritis of her right ankle and the proximal interphalangeal joint of her right middle finger. Thus, prednisolone was reinitiated combined with methotrexate, and the patient went into remission, which persists one year after prednisolone tapering. The appearance of arthritis in both knees in the absence of bone lesions and the emergence of severe arthritis of the ankle after remission of spinal bone lesions suggest that CRMO and juvenile idiopathic arthritis may coexist and be causally related.

Hubungan Sikap dan Karakteristik Pasangan Usia Subur (PUS) dengan Keikutsertaan dalam Program KB di Wilayah Kerja UPT Puskesmas Sungai Raya Kecamatan Sungai Raya Kabupaten Aceh Timur

2020 ◽  
Vol 8 (2) ◽  
pp. 105-114
Author(s):  
Ainul Mardhiah ◽  
Nova Hasbani Prima Dewi ◽  
Aminy Aminy
Keyword(s):  
Family Planning ◽  
Family Planning Program ◽  
The Elderly ◽  
P Value ◽  
Planning Program ◽  
Elderly Age ◽  
Chi Square ◽  
Cross Sectional ◽  
The Family ◽  
Relationship Of

The family planning program also aims to improve the quality of the family in order to generate a sense of security, peace and hope of a better future in realizing the prosperity of birth and inner happiness. Allegedly the factor causing EFA participation in the family planning program is characteristic. The purpose of this research is to know the relationship of attitude and characteristic of Elderly Age Couple (PUS) with participation in family planning program at UPT Puskesmas Sungai Raya Sungai Raya District, East Aceh regency 2018. The research design used was analytic survey with cross sectional design. The population of this study is all Pairs Age of Fertile located in Work Area UPT Sungai Raya Public Health Service Center in January to December 2017 which amounted to 1897 people. Sampling using Slovin formula, obtained as many as 95 samples. The study was conducted from 7-17 July 2018 using questionnaires by interview. Statistical test using chi-square test. Result of research indicate that majority of fertile couple couples (PUS) participate in family planning program as much as 67 respondents (70,5%). Statistically there is relationship of attitude and characteristic of Elderly Age Couple (EFA) with non participation in family planning program in Working Area of UPT Puskesmas Sungai Raya Sungai Raya District of East Aceh Regency 2018 with p value <0,1. It is recommended that the family planning program holders in UPT Puskesmas Sungai Raya Sungai Raya District of East Aceh District to invite cross-sectoral figures to hold meetings to create mini workshop plans at least once a month to increase the participation of the Elderly Age Couple (PUS) in family planning programs. Keyword : Family Planning Program, Attitudes, CharacteristicsABSTRAKProgram KB juga bertujuan untuk meningkatkan kualitas keluarga agar dapat timbul rasa aman, tentram, dan harapan masa depan yang lebih baik dalam mewujudkan kesejahteraan lahir dan kebahagiaan batin. Diduga faktor yang menyebabkan ketidakikutsertaan PUS dalam program KB adalah karakteristik. Tujuan penelitian ini untuk mengetahui hubungan sikap dan karakteristik Pasangan Usia Subur (PUS) dengan keikutsertaan dalam program KB di Wilayah Kerja UPT Puskesmas Sungai Raya Kecamatan Sungai Raya Kabupaten Aceh Timur tahun 2018. Desain penelitian yang digunakan adalah survei analitik dengan rancangan bedah lintang. Populasi dari penelitian ini adalah seluruh Pasangan Usia Subur yang berada di Wilayah Kerja UPT Puskesmas Sungai Raya pada bulan Januari sampai dengan Desember tahun 2017 yang berjumlah 1.897 orang. Pengambilan sampel menggunakan rumus Slovin, didapatkan sebanyak 95 sampel. Penelitian dilaksanakan dari tanggal 7-17 Juli tahun 2018 menggunakan kuesioner dengan cara wawancara. Uji statistik menggunakan uji chi-square. Hasil penelitian menunjukkan bahwa mayoritas Pasangan Usia Subur (PUS) ikut serta dalam program KB yaitu sebanyak 67 responden (70,5%). Secara statistik ada hubungan sikap dan karakteristik Pasangan Usia Subur (PUS) dengan ketidakikutsertaan dalam program KB di Wilayah Kerja UPT Puskesmas Sungai Raya Kecamatan Sungai Raya Kabupaten Aceh Timur tahun 2018 dengan p value < 0,1. Sebaiknya pemegang program KB di UPT Puskesmas Sungai Raya Kecamatan Sungai Raya Kabupaten Aceh Timur agar mengajak tokoh lintas sektor agar mengadakan pertemuan untuk membuat rencana loka karya mini setidaknya satu bulan sekali untuk meningkatkan keikutsertaan Pasangan Usia Subur (PUS) dalam program KB.Kata Kunci : Program KB, Sikap, Karakteristik

Sign in / Sign up

Export Citation Format

Share Document