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Inicio Revista Colombiana de Reumatología (English Edition) Chronic recurrent multifocal osteomyelitis in pediatrics in a tertiary center
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Case report
Chronic recurrent multifocal osteomyelitis in pediatrics in a tertiary center
Osteomielitis crónica multifocal recurrente en pediatría en un hospital terciario
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Carlos Marcilla Vázquez
Corresponding author
carlos.marcilla11@gmail.com

Corresponding author.
, María Isabel Buedo Rubio, María Ángeles García Morales, Tomás Hernández Bertó, Laura Cabañas Lozano
Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Received 06 April 2020. Accepted 09 June 2020
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Table 1. Clinical and analytical data, imaging tests and treatment given in three patients diagnosed with CRMO.
Abstract
Introduction

Chronic recurrent multifocal osteomyelitis (CRMO), also called chronic non-bacterial osteomyelitis, is an autoinflammatory disease characterized by bone involvement, recurrent flare-ups, and the lack of microbiological isolation. It is a diagnosis of exclusion, and the fundamental basis of treatment is non-steroidal anti-inflammatory drugs. The objective of the study is to describe our experience as a result of three girls diagnosed with CRMO, highlighting the clinical presentation, the findings in the complementary tests, the treatment, and the evolution of the disease.

Patients and methods

Retrospective chart review of children with CRMO in the last 5 years, being followed-up in a pediatric rheumatology clinic in a tertiary center.

Results

The cases are presented of 3 patients diagnosed with CRMO, all of them young girls, with a mean age of 11 years, who consulted due to pain and functional impotence. It was in single location in two cases, and the other with several sources of pain, at cervical and lumbar level, associated with weakness of the upper and lower limbs. Two of the cases received antibiotic treatment. One girl responded to treatment with anti-inflammatory drugs and another required combining corticosteroids. The remaining case, in addition to anti-inflammatory drugs and corticosteroids, required intravenous pamidronate.

Conclusions

With this study, and despite the small sample size, the aim was to highlight the importance of this, in many cases unknown and underdiagnosed, pathology, and to stress the importance of establishing a diagnostic and therapeutic protocol for the correct approach to this disease.

Keywords:
Chronic recurrent multifocal osteomyelitis
Non-bacterial osteomyelitis
Auto-inflammation
Pediatrics
Resumen
Introducción

La osteomielitis crónica multifocal recurrente (OCMR), también conocida como osteomielitis crónica no bacteriana, es una enfermedad autoinflamatoria caracterizada por afectación ósea, de curso en brotes y en ausencia de aislamiento microbiológico. El diagnóstico es de exclusión y el pilar fundamental del tratamiento son los antiinflamatorios noesteroideos (AINES). El objetivo del estudio es describir nuestra experiencia de tres niñas diagnosticadas de OCMR, destacando la presentación clínica, los hallazgos en las pruebas complementarias, el tratamiento y la evolución de la enfermedad.

Pacientes y métodos

Revisión retrospectiva de historias clínicas de niños diagnosticados de OCMR en los últimos cinco años, en seguimiento en consulta de reumatología pediátrica de un hospital terciario.

Resultados

Presentamos tres pacientes diagnosticadas de OCMR, todas ellas mujeres adolescentes, con media de edad de 11 años. Consultaron por dolor e impotencia funcional, dos en una única localización y la otra por varios focos de dolor, a nivel cervical y lumbar, asociando debilidad de miembros superiores e inferiores. Con respecto al tratamiento, dos recibieron tratamiento antibiótico. Una niña respondió a antiinflamatorios; otra precisó asociar corticoides, y la restante, además de antiinflamatorios y corticoides, necesitó pamidronato intravenoso.

Conclusiones

Con este estudio y a pesar del pequeño tamaño muestral, se pretende resaltar la importancia de esta patología, en muchos casos desconocida e infradiagnosticada, e insistir en la importancia de establecer un protocolo diagnóstico y terapéutico para su correcto abordaje.

Palabras clave:
Osteomielitis crónica multifocal recurrente
Osteomielitis no bacteriana
Autoinflamación
Pediatría

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