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Case Reports: Rare disease
Chronic recurrent multifocal osteomyelitis with a comprehensive approach to differential diagnosis of paediatric skull pain
  1. Ross Fraleigh1,2,
  2. Xing-Chang Wei3,4,
  3. Weiming Yu4,5 and
  4. Paivi Maria Miettunen1,2,4
  1. 1Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta, Canada
  2. 2Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
  3. 3Diagnostic Imaging, Alberta Children's Hospital, Calgary, Alberta, Canada
  4. 4Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  5. 5Pathology and Laboratory Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
  1. Correspondence to Dr Paivi Maria Miettunen; paivi.miettunen{at}albertahealthservices.ca

Abstract

A girl in middle childhood was referred to rheumatology with a 1-month history of progressive skull pain, preceded by fleeting musculoskeletal symptoms. Apart from a scaly rash on her scalp, she was well, with moderately elevated inflammatory markers. Skull imaging (radiographs, CT and MRI) revealed osteolytic lesions, soft tissue swelling and pachymeningeal enhancement at frontal and temporal convexities. Langerhans cell histiocytosis, bone infection/inflammation or malignancy was considered. Skin and bone biopsies eventually ruled out mimicking diseases and confirmed the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). She was treated with intravenous pamidronate (IVPAM) for 9 months, with rapid resolution of pain and gradual resolution of bony abnormalities. She remains in remission at 15-month follow-up. While CRMO can affect any bone, skull involvement is extremely rare, with a broad differential diagnosis. We recommend bone biopsy to confirm skull CRMO. The patient achieved excellent clinical and radiological response to IVPAM.

  • Paediatrics (drugs and medicines)
  • Pain
  • Musculoskeletal and joint disorders
  • Bone and joint infections
  • Paediatric oncology

http://dx.doi.org/10.1136/bcr-2022-252471

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    Footnotes

    • Contributors RF—drafting the article or revising it critically for important intellectual content; conception and design, acquisition of data or analysis and interpretation of data; final approval of the version published. X-CW—conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version published. WY—conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version published. PMM—conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version published; agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.