Chronic recurrent multifocal osteomyelitis (CRMO) is primarily a diagnosis of exclusion. It is an idiopathic inflammatory disorder of bone seen primarily in children and adolescents.
Females are more commonly affected than males.
The typical clinical picture of CRMO is a child or young adult with a history of chronic multifocal bone pain, in whom biopsy of osseous lesions shows osteomyelitis with failure to culture any organisms.
CRMO is characterised by multifocal non-pyogenic inflammatory bone lesions, a course of exacerbations and remissions, and an association with other inflammatory disorders.
Findings are usually suggestive rather than pathognomonic.
Initially to examine the symptomatic site:
- early stages: osteolytic lesion
- later stages: progressive sclerosis 3
Lesions can range between purely osteolytic, osteolytic with a sclerotic rim, mixed lytic and sclerotic, and purely sclerotic.
Useful for determining the extent of disease and for further surveillance. Typical findings are of bone marrow oedema:
- T1: hypointense
- T2: hyperintense
- T1+C: enhancement
Treatment and prognosis
Longterm clinical follow up with whole body MRI may be needed until patient is in radiological remission or a steady state is achieved.
History and etymology
The syndrome of CRMO was originally described in 1972 in four children under the name “subacute and chronic recurrent osteomyelitis'' 1. The term CRMO was first used by Probst et al 2.
- 1. GiedionA, Holthusen W, Masel LF, Vischer D. Subacute and chronic “symmetrical” osteomyelitis [in French]. Ann Radiol (Paris)1972;
- 2. ProbstFP, Bjorksten B, Gustavson KH. Radiological aspect of chronic recurrent multifocal osteomyelitis. Ann Radiol (Paris)1978;
- 3. Bj0rkstenB, Boquist L. Histopathological aspects of chronic recurrent multifocal osteomyelitis. J Bone Joint Surg Br1980;