Abstract
Background
CRMO is an autoinflammatory bone disease mainly affecting the paediatric age group. It may have overlapping features with other rheumatological diseases. I report a case of a 7-year-old boy who presented with fever, persistent limp and pain at multiple sites involving the extremities.
Methods
His complaint started with pain in the gluteal region with an accompanying limp. Two months later, he started having fever, pain and localised swelling around multiple sites - right knee, right ankle and left wrist associated with intermittent night pain and morning stiffness. MSK examination revealed localised peri-articular swelling and restriction of movements involving bilateral knees, ankles, hips and wrists. Lab reports showed low hemoglobin, neutrophilic leucocytosis, elevated platelets, CRP and ESR. Muscle enzymes (CPK, SGPT, SGOT, LDH), bone profile, ferritin, RF, ASO titer, ANA and ANA profile were normal. Whole body MRI (WBM) revealed multifocal bone marrow edema predominantly in metaphyseal regions involving multiple bones. Polymyositis and mild effusions were noted in bilateral hips and knees. He was put on oral naproxen, prednisolone, methotrexate and pamindronate infusion for two days. He responded dramatically and continues to remain well at two weeks' follow up.
Results
CRMO is mainly associated with severe acne, palmoplantar pustulosis, generalised pustular psoriasis, pyoderma gangrenosum, ankylosing spondylitis and inflammatory bowel disease. There are only 2-3 reported cases of CRMO associated myositis in adolescents to the best of my knowledge. This child will be the youngest diagnosed CRMO with polymyositis.
Conclusion
When any child presents with fever, recurrent or chronic night pain and/or swelling at multiple sites with moderate elevation of inflammatory markers, we should suspect CRMO and our first choice of investigation should be whole body MRI to reveal associated extra-osseous lesions.
Disclosures
D.B. Pandya None.