CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITI S (CRMO) - CASE-REPORT ON ADULT CRMO WITH PALMOPLANTAR PUSTULOSIS (PPP)

We have recently reviewed from the world literature the rare disease e ntity of chronic recurrent multifocal osteomyelitis (CRMO) and discuss ed the nosologic association with pustulosis palmoplantaris. Here we p resent the case of a young female patient with adult CRMO from our own clinic. We point out the association between skin and bone disease. T his case is of interest for its histopathologic relation to both the p lasmacellular and sclerosing chronic osteomyelitides and to the pustul ous hyperostotic spondarthritides. We discuss the hypothesis of presum ably postinfectious ''reactive osteomyelitis'' in which the immunopath ologic lympho-plasmacellular process seems to play the major role. In our 21-year old patient we found simultaneously clinical symptoms of t he skin and the bone as well as a sterno-spondylo-metaphyseal type of multifocal osteomyelitis. The latter is demonstrated by MR tomography as bisegmental osteomyelitis, as sternal osteochondritis and ''Brodie- like'' metaphyseal lesion of the knee. We discuss differential diagnos is to hyperostotic spondarthritides. For the first time, long-term tre atment with calcitonin for CRMO is described in this patient resulting in a benefitial outcome of the patient's disease so far. From our exp erience, surgical interventions can be prevented in CRMO. - We demonst rate skeletal residues and the questions that arise from these finding s.