Chronic recurrent multifocal osteomyelitis (CRMO) - atypical


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.