Chronic Recurrent Multifocal Osteomyelitis on the Distal Tibia and Fibula

Jeon-Gyo Kim; Heui-Chul Gwak; Min Young Her; Dong-Gyun Kim

doi:10.4055/jkoa.2015.50.2.160

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Kim, Gwak, Her, and Kim: Chronic Recurrent Multifocal Osteomyelitis on the Distal Tibia and Fibula

Case Report

Journal of the Korean Orthopaedic Association 2015; 50(2): 160-164.

Published online: 30 April 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.2.160

Chronic Recurrent Multifocal Osteomyelitis on the Distal Tibia and Fibula

Jeon-Gyo Kim, M.D.^*, Heui-Chul Gwak, M.D., Min Young Her, M.D.^†, Dong-Gyun Kim, M.D.

Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

^*Medical Department of 3821th Unit, Korea Army, Inje, Korea.

^†Department of Interanl Medcine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Correspondence to: Heui-Chul Gwak, M.D. Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. TEL: +82-51-890-6996, FAX: +82-51-890-6129, ortho1@hanmail.net

Received 3 January 2014 Revised 6 April 2014 Accepted 10 November 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious inflammatory bone disease that occurs mainly in children and adolescents. The clinical presentation shows imprecise bone pain, while radiologic findings and histologic exam are similar to those of infectious osteomyelitis. It is a rare disease, which is difficult to distinguish from other diseases, therefore it could be misdiagnosed. We report on a case of CRMO on the distal tibia and fibula in an 11-year-old boy.

Keywords: chronic recurrent multifocal osteomyelitis, tibia, fibula

Figures and Tables

Figure 1

Chronic recurrent multifocal osteomyelitis in the ankle of an 11-year-old boy. (A) Anterior-posterior plain radiography of the right ankle shows an osteolytic lesion of the physeal plate at the distal fibula. (B) Coronal T2 weighted magnetic resonance imaging shows an increased signal change around the distal fibula and a periosteal reaction.

Figure 2

Histologic feature shows mixed infiltration of inflammatory cells including polymorphonuclear leukocytes, lymphocytes, and plasma cells (H&E, ×400).

Figure 3

Three months postoperative, anterior-posterior plain radiograph of the right ankle shows disappearance of the osteolytic lesion.

Figure 4

(A) Anterior-posterior plain radiograph of the right ankle shows an osteolytic lesion on the physeal plate at the distal tibia. (B) ^99-mTcWhite blood cell scan shows no definite evidence of abnormal radioactivity suggesting an infectious lesion. (C) Anterior-posterior plain radiograph of the right ankle shows a reduction in the osteolytic lesion after six months.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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