Chronic recurrent multifocal osteomyelitis
The authors discuss the diagnostic and prognostic problem of chronic recurrent osteomyelitis (CRMO) described for the first time in 1972 by Giedione. This relatively rare disease of unknown origin is characterized by a slow onset with oedema and pain at several sites of the locomotor apparatus which occur concurrently or consecutively and are followed by relapses. The body temperature is normal or slightly elevated. CRMO is sometimes associated also with palmoplantar pustulosis. The authors evaluate six patients wih CRMO treated in 1988-1994 (4 boys and 2 girls), age 7-13 years at the onset of the disease. There were at least 2 and not more the 4 foci per patient. The clinical symptoms before the first orthopaedic examination persisted for 1-5 weeks. Concurrent skin disease was not observed. Relapses of symptoms were described in the patients at 8 sites with remissions lasting 4-16 weeks. The most frequent site in the investigated group is the distal metaphysis of the femur and proximal metaphysis of the tibia (11 times), the medial portion of the clavicle (twice) and the short bones of the toes (three times). Classical X-ray diagnosis revealed skeletal changes consistent with the appearance of acute or chronic haematogenic osteomyelitis. All-body scintigraphy 99mTc revealed an increased cumulation of the radiopharmaceutical preparation in the focus sooner than the classical X-ray picture. Bacteriological examination of specimens obtained from blood and material from the osseous foci does not identify the causal agent. FW and CRP examination gave elevated values and frequently also leucocytosis. Antibiotics administered for 4-32 weeks produced no detectable effect, non-steroid antiphlogistics mitigated subjective complaints. Sequestration was not observed in the investigated patients. Post-inflammatory premature closing of the growth zones on the short bones of the feet are found as a rule. Key words: chronic multifocal recurrent osteomyelitis, child age.