Chronic Multifocal Osteomyelitis – Is Mycobacterium avium Complex Really the Culprit? A Case Report in an Adult Female

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Jordan E. Johnson ◽  
Marco S. Gupton ◽  
Jordan Finn ◽  
Chenthuran Deivaraju
Keyword(s):  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Lytic Lesions ◽  
Tuberculous Osteomyelitis ◽  
Multifocal Osteomyelitis ◽  
Adults And Children ◽  
Chronic Multifocal Osteomyelitis ◽  
Acute And Chronic Inflammation ◽  
Immunocompetent Adults

Introduction:There are reports which describe multiple lytic lesions seen on X-ray resulting from a non-tuberculous Mycobacterium skeletal infection in immunocompetent adults and children. AdditionallyIn addition, similar multifocal lesions have also been described in chronic recurrent multifocal osteomyelitis (CRMO) which is more common in children but has have rarely been reported in adults. We present a case of a 47-year-old female who presented with multiple osteolytic lesions and discuss how her diagnosis overlaps with CRMO and multifocal non-tuberculous osteomyelitis associated with Mycobacterium avium complex (MAC). Case Report:A 47-year-old female presented with a mass at her left sternoclavicular joint. Biopsy of the lesion showed acute and chronic inflammation suggesting osteomyelitis. The patient was on intravenousIV antibiotics with some improvement. After three 3 ½ and a half months, she was having knee pain and imaging showed another lesion and a bone scan found a third. Delayed cultures grew Mycobacterium avium complexMAC but ultimately the patient improved when she was taking naproxen for multifocal osteomyelitis. Conclusion:Multifocal lytic lesions on imaging in an adult can be multifocal osteomyelitis that, like in pediatric patients, may be treated best with nonsteroidal anti-inflammatory medications as with the patient in this case. Keywords:Multifocal Osteomyelitis, Mycobacterium Avium Complex, Osteitis Multifocal Osteomyelitis, Mycobacterium avium complex, osteitis.

P085 Chronic recurrent multifocal osteomyelitis: about 2 cases

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Saoussen Miladi ◽  
Yasmine Makhlouf ◽  
Alia Fazaa ◽  
Mariem Sellami ◽  
Kmar Ouenniche ◽  
...  
Keyword(s):  
Bone Scintigraphy ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Whole Body ◽  
Treatment Modalities ◽  
Early Assessment ◽  
Greater Trochanter ◽  
Left Ankle ◽  
Lytic Lesions ◽  
Multifocal Osteomyelitis ◽  
The Right

Abstract Background Chronic recurrent multifocal osteomyelitis (CRMO) also known as aseptic osteomyelitis is a rare auto-inflammatory disease with an incidence estimated at 4/100 000 population [1]. The aim of our work was to report two cases of CRMO that illustrate challenges in the diagnosis of this rare disease. Method We report the case of two patients diagnosed with CRMO. Clinical, biological and radiological data as well as disease outcomes were described. We also collected data about treatment modalities. Results Two patients aged of 7 and 10 years respectively, without any notable pathological history, presented recurrent episodes multifocal painful swelling of limbs. In the first case, the symptoms concerned the left ankle and knee as well as the left hip, all associated with lameness and an altered general condition, with neither fever nor skin manifestations. In the second case, the swelling involved the right shoulder, right hip and the left ankle. There was no elevated CRP or ESR in any of patients. Immunological status (RF, anti-CCP, AAN) as well as the HLA-B27 antigen test were negative. In the first patient, standard radiographs showed lytic lesions of the proximal metaphysis of the tibia, the greater trochanter and the left lateral malleolus. MRI of the pelvis, knee, and sternum of the first patient revealed edematous involvement of the left greater trochanter, the right ilium, the proximal metaphyseal region of the tibia and the right edge of the sternum, whereas in the second patient, a whole-body MRI showed inflammatory signs over the left greater trochanter, the insertion of the gluteus medius and obturator externus, right trochanteric bursitis and oedema of the entire right ilium. In the first patient, bone scintigraphy showed intense uptake of radioisotopes in the left ilium, the 7 th right costo-vertebral junction, the trochanteric mass, the upper end of the tibia and the lower end of the left fibula. Bone biopsy showed bone remodeling in both cases without evidence of infection or tumor. The diagnosis of CRMO was retained, supported by the prompt response to NSAIDs and short-term corticosteroid therapy. However, the second patient presented, 8 years later, pain in the sterno-clavicular joint as well as the right hip. A relapse of the disease was confirmed by MRI. Therapeutic escalation with zoledronic acid 0.025 mg/kg intravenous infusion every six months allowed the resolution of the symptoms. Conclusion These observations illustrated a rare disorder in children, characterized by lytic lesions predominantly in the metaphysis of long bones. Bone scintigraphy allowed an early assessment of disease extension and histological examination ruled out a malignant tumor and an infection. The first-line treatment is anti-inflammatory drugs. In case of failure, bisphosphonates seem to be effective.

scholarly journals Unusual Manifestation of Ulcerative Colitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Amna Basheer M. Ahmed ◽  
Badr M. Rasheed Alsaleem
Keyword(s):  
Ulcerative Colitis ◽  
Unknown Origin ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Deficiency Anemia ◽  
Rheumatic Manifestations ◽  
Multifocal Osteomyelitis ◽  
Inflammatory Bowel ◽  
Chronic Multifocal Osteomyelitis ◽  
Relationship Of ◽  
The Relationship

The relationship of inflammatory bowel disease (IBD) and chronic recurrent multifocal osteomyelitis (CRMO) is understood as extraintestinal rheumatic manifestations. CRMO is a chronic, relapsing, inflammatory, noninfectious disorder of the skeletal system of unknown origin. The disease course is not always recurrent. The association of CRMO and ulcerative colitis (UC) is very rarely reported. We report a case of a 10-year-old Saudi female who was diagnosed with CRMO, when she developed fever in association with left foot pain, and ulcerative colitis was confirmed endoscopically and histologically based on a previous settled diarrheal illness and severe iron deficiency anemia which required blood. Both conditions responded well to IBD therapy. To the best of our knowledge, this is the first reported case of chronic, multifocal osteomyelitis associated with pediatric UC in Saudi Arabia. This report supports the use of IBD therapy in treating CRMO.

scholarly journals Recurrent Multifocal Osteomyelitis Due to Mycobacterium avium Complex

1996 ◽  
Vol 23 (5) ◽  
pp. 1194-1195 ◽  
Author(s):  
A. P. Kourtis ◽  
C. C. Ibegbu ◽  
J. A. Snitzer ◽  
S. R. Nesheim
Keyword(s):  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Multifocal Osteomyelitis

scholarly journals Mycobacterium avium Complex Cervical Lymphadenitis in an Immunocompetent Adult

2010 ◽  
Vol 17 (9) ◽  
pp. 1488-1490 ◽  
Author(s):  
Joshua B. Christensen ◽  
John Koeppe
Keyword(s):  
Rare Disease ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Interleukin 12 ◽  
Common Disease ◽  
Immune Competence ◽  
Cervical Lymphadenitis ◽  
Immunocompetent Adult ◽  
Ifn Γ ◽  
Immunocompetent Adults

ABSTRACT Nontuberculosis mycobacterial cervical lymphadenitis is a relatively common disease in immunocompetent children but a rare disease in immunocompetent adults. We report the diagnosis and treatment of Mycobacterium avium complex cervical lymphadenitis in an adult female. Our evaluation of immune competence, including gamma interferon (IFN-γ) and interleukin-12 (IL-12) signaling, found no evidence of deficiency.

scholarly journals Investigation of Spa Pools Associated with Lung Disorders Caused by Mycobacterium avium Complex in Immunocompetent Adults

2004 ◽  
Vol 70 (8) ◽  
pp. 4906-4910 ◽  
Author(s):  
Richard Lumb ◽  
Richard Stapledon ◽  
Andrew Scroop ◽  
Peter Bond ◽  
David Cunliffe ◽  
...  
Keyword(s):  
Lung Disease ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Public Awareness ◽  
Health Departments ◽  
Fourth Case ◽  
Environmental Bacteria ◽  
Immunocompetent Adults ◽  
Culture Positive

ABSTRACT Three cases of Mycobacterium avium complex-related lung disorders were associated with two poorly maintained spa pools by genotypic investigations. Inadequate disinfection of the two spas had reduced the load of environmental bacteria to less than 1 CFU/ml but allowed levels of M. avium complex of 4.3 × 104 and 4.5 × 103 CFU/ml. Persistence of the disease-associated genotype was demonstrated in one spa pool for over 5 months until repeated treatments with greater than 10 mg of chlorine per liter for 1-h intervals eliminated M. avium complex from the spa pool. A fourth case of Mycobacterium avium complex-related lung disease was associated epidemiologically but not genotypically with another spa pool that had had no maintenance undertaken. This spa pool contained low numbers of mycobacteria by smear and was culture positive for M. avium complex, and the nonmycobacterial organism count was 5.2 × 106 CFU/ml. Public awareness about the proper maintenance of private (residential) spa pools must be promoted by health departments in partnership with spa pool retailers.

Polymicrobial Intracerebral Abscess Growing Achromobacter Xylosoxidans and Mycobacterium Avium Complex

2020 ◽  
Author(s):  
Juliana Rotter ◽  
Christopher S. Graffeo ◽  
Hannah E. Gilder ◽  
Lucas P. Carlstrom ◽  
Avital Perry ◽  
...  
Keyword(s):  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Achromobacter Xylosoxidans ◽  
Intracerebral Abscess
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