Chronic recurrent multifocal osteomyelitis (CRMO) - atypical

Case contributed by Jeremy Jones


Generalized 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.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.