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*Corresponding author:Ammar Chaudhry, Director of Precision Imaging Lab, Assoc. Director of Radiology and Imaging Informatics, City of Hope National Cancer Center, Beckman Research Institute, 1500 East Duarte Road, Duarte, CA 91010, USA
Received: August 25, 2018; Published: August 31, 2018
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Background: Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a rare auto-inflammatory condition characterized by relapsing and remitting episodic bone pain most commonly affecting epiphyseal and diaphyseal regions of long bones. We present an unusual case of CRMO presenting as recurrent left lower quadrant pain and bilateral upper extremity pain.
Case Presentation: A 30-year-old Ethiopian female presented to the emergency department with intermittent worsening left lower quadrant pain and bilateral upper extremity pain. Past medical history is significant for sickle cell anemia. Physical exam including vital signs were unremarkable except for tenderness to palpation in bilateral upper extremity and left lower quadrant (posterior greater than anterior). Complete blood count revealed only mild anemia (Hemoglobin 10.1 mg/dL), but was otherwise unremarkable, as was the comprehensive metabolic panel. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated at 71 mm/hr and 12.3mg/L.
Conclusion: In patients with episodic extremity and abdominal pain, CRMO should be considered, especially in the absence of stigmata of infectious process or inflammatory bowel disease. The diagnosis of CRMO can be suggested by osteosclerosis on imaging studies and confirmed with biopsy. CRMO is usually treated with immunosuppressive therapy (glucocorticoids and interferon gamma) and NSAIDs. In our case, patient was successfully discharged to home on oral prednisone and NSAIDs (non-steroidal anti-inflammatory drugs). On follow-up visit two weeks after discharge, patient noted near complete resolution of her symptoms without interval relapse.
Keywords: Chronic; Osteomyelitis; Diagnosis; Auto-Inflammatory; Extremity; Imaging; Episodic; Metaphysis; Neoplasm; Osteomyelitis
Abbreviations: CRMO: Chronic Recurrent Multifocal Osteomyelitis; ESR: Erythrocyte Sedimentation Rate; CRP: C-Reactive Protein; LDH: Lactate Dehydrogenase; NSAID: Nonsteroidal Anti-Inflammatory Drug; MRI: Magnetic Resonance Imaging
Abstract | Background | Case Presentation | Discussion and Conclusions | Acknowledgment | Availability of Data and Materials | Author’s Contributions | Ethics Approval and Consent to Participate | Consent for Publication | References |