Chronic reactive multifocal osteomyelitis (CRMO) - atypical

Case contributed by Dr Jeremy Jones


Generalised leg pain and specifically, right ankle pain stopping activities at school and requiring non-involvement in school games.

Patient Data

Age: 10 years
Gender: Female

Multifocal, symmetrical STIR high signal in the metaphyses and epiphyses of the distal femora, proximal and distal tibiae and fibulae.

Normal radiograph of the left ankle (AP only).

Case Discussion

On imaging alone, the diagnosis is not clear. The differential is wide and includes:

  • an infiltrative process (e.g. leukemia) although the distribution, symmetry and proximal femoral sparing is against this
  • a storage disorder (e.g. Gaucher disease) although a normal radiograph makes this much less likely (expect Erlenmeyer flask)
  • a chronic inflammatory disorder (e.g. CRMO)

A biopsy was performed which yielded inflammatory cells only and based on the that, and the imaging, the child was treated for CRMO.

On treatment, symptoms improved.

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Case information

rID: 56404
Published: 30th Oct 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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