Presentation
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
From the case:
Chronic recurrent multifocal osteomyelitis (CRMO) - atypical
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Coronal STIR
Multifocal, symmetrical STIR high signal in the metaphyses and epiphyses of the distal femora, proximal and distal tibiae and fibulae.
From the case:
Chronic recurrent multifocal osteomyelitis (CRMO) - atypical
Frontal
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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