J Korean Orthop Assoc.  2015 Apr;50(2):160-164. 10.4055/jkoa.2015.50.2.160.

Chronic Recurrent Multifocal Osteomyelitis on the Distal Tibia and Fibula

• Kim JG
• Gwak HC
• Her MY
• Kim DG

• KMID: 2106753
• DOI: http://doi.org/10.4055/jkoa.2015.50.2.160

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious inflammatory bone disease that occurs mainly in children and adolescents. The clinical presentation shows imprecise bone pain, while radiologic findings and histologic exam are similar to those of infectious osteomyelitis. It is a rare disease, which is difficult to distinguish from other diseases, therefore it could be misdiagnosed. We report on a case of CRMO on the distal tibia and fibula in an 11-year-old boy.

Keyword

chronic recurrent multifocal osteomyelitis; tibia; fibula

MeSH Terms

Adolescent
Bone Diseases
Child
Fibula*
Humans
Male
Osteomyelitis*
Rare Diseases
Tibia*

Figure

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  Figure 1 Chronic recurrent multifocal osteomyelitis in the ankle of an 11-year-old boy. (A) Anterior-posterior plain radiography of the right ankle shows an osteolytic lesion of the physeal plate at the distal fibula. (B) Coronal T2 weighted magnetic resonance imaging shows an increased signal change around the distal fibula and a periosteal reaction.

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  Figure 2 Histologic feature shows mixed infiltration of inflammatory cells including polymorphonuclear leukocytes, lymphocytes, and plasma cells (H&E, ×400).

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  Figure 3 Three months postoperative, anterior-posterior plain radiograph of the right ankle shows disappearance of the osteolytic lesion.

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  Figure 4 (A) Anterior-posterior plain radiograph of the right ankle shows an osteolytic lesion on the physeal plate at the distal tibia. (B) 99-mTcWhite blood cell scan shows no definite evidence of abnormal radioactivity suggesting an infectious lesion. (C) Anterior-posterior plain radiograph of the right ankle shows a reduction in the osteolytic lesion after six months.

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