CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS - HOW TO SUGGEST THIS DIAGNOSIS

Chronic recurrent multifocal osteomyelitis is a rare disorder that aff ects children and teenagers. Clinically, it is characterized by insidi ous onset of local swelling and pain in several metaphyses. A symmetri c, recurrent and multifocal pattern is usual. Spinal involvement is po ssible. Inconstant association with a cutaneous affection (palmoplanta r pustulosis, acne fulminans, psoriasis), or less frequently with an i nflammatory chronic gut disorder is described. Pathogenesis usually re cognized is an enthesopathy. Enthesitis may progress to the osseous pa rt of the enthese and produce an aseptic chronic osteomyelitis. Biopsy specimen with culture is certainly necessary to rule out bacterial os teomyelitis and bone tumor. It is particularly true when the bone lesi on is isolated. Disease course is benign and self-limited. The clinica l course is characterized by recurrences and remissions occurring for 6 to 10 years. Treatment based on non steroid antiinflammatory drugs i s usually effective.