This is a case of chronic recurrent multifocal osteomyelitis (also known as chronic nonbacterial osteomyelitis). On initial radiographs of the right ankle, there was increasing lucency of the distal tibial metaphysis and MRI of this region revealed STIR hyperintensity with corresponding T1 hypointensity. Whole body MRI was used which demonstrated increased T2/STIR signal and decreased T1 signal of the bilateral distal tibias. Biopsy of the right distal tibia revealed reactive bone showing reparative/remodeling changes without the presence of microorganisms.

CO-AUTHORS:
Michael Cooley, MD
Travis Bevington, MD