Chronic recurrent multifocal osteomyelitis in children: a report of 17 cases

Chronic recurrent multifocal osteitis (OCRM) is a rare condition in childre n, of unknown aetiology, which may be misdiagnosed as osteomyelitis, arthri tis or tumour. Patients and methods, - We present a retrospective multicentric study of 17 patients (five boys and 12 girls) with an average follow-up of 7.5 years ( six months-25 years). Results. - A spectrum of presenting features is possible, ranging from bone lesions alone to lesions combined with arthritis, palmoplantar pustulosis or psoriasis. The diagnosis was delayed from two weeks to five years. Roent genographic evaluation was often normal at the beginning of the disease or showed nonspecific bone reactions. Radioisotope bone scans assisted in esta blishing the diagnosis and in identifying lesions that were initially clini cally silent. Bone biopsies were performed in seven cases. Histopathologica l examination showed only mild inflammatory nonspecific changes. Microbiolo gical cultures were always negative. Treatments were different according to the evolution of the disease and the hospital. There was no response to antibiotics in seven patients. The resp onse to nonsteroidal anti-inflammatory agents and steroids was moderate and often transient. Salazopyrine and pamidronate treatment used in two patien ts allowed a durable remission. We lost sight of four patients, pain persis ted in three in spite of treatment, it disappeared in two with treatment, m ild pain persisted in five without treatment and remission occurred in thre e without treatment. Conclusion, - This study clarifies the clinical and radiologic features of chronic recurrent multifocal osteomyelitis. The recognition of this rare en tity is often delayed and difficulties in patient management sometimes emer ge from its usual protracted course. (C) 2001 Editions scientifiques et med icales Elsevier SAS.