Bone scintigraphy in diagnosing chronic recurrent multifocal osteomyelitis

Document Type: Case Report

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Pediatrics Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

A 10-year-old boy was referred to us for evaluation of FUO accompanied with bone pain in both calves. Three hours after intravenous injection of 13 mCi of 99mTc-MDP, whole body scan in multiple spot views was performed. The scan showed symmetrical areas of diffusely increased tracer uptake in multiple long bones. Histopathologic evaluation confirmed osteosclrosis and fibrotic changes without any bacterial growth in the specimen culture. Based on patient’s history, lab results, bone scan and histopathologic findings, chronic recurrent multifocal osteomyelitis (CRMO) was considered as the most likely diagnosis. Dramatic response to NSAIDs and pamidronate therapy confirmed the diagnosis of CRMO.

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  1. Mandell GA, Contreras SJ, Conard K, Harcke HT, Maas KW. Bone scintigraphy in the detection of chronic recurrent multifocal osteomyelitis. J Nucl Med. 1998 Oct;39(10):1778-83.
  2. Falip C, Alison M, Boutry N, Job-Deslandre C, Cotten A, Azoulay R, Adamsbaum C. Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol. 2013 Mar;43(3):355-75.
  3. Buck FM, Treumann TC, Winiker H, Strobel K. Chronic recurrent multifocal osteomyelitis (CRMO) with symmetric involvement of both femora: X-ray, bone scintigram, and MR imaging findings in one case. J Magn Reson Imaging. 2007 Aug;26(2):422-6.
  4. Rosenberg ZS, Shankman S, Klein M, Lehman W. Chronic recurrent multifocal osteomyelitis. AJR Am J Roentgenol. 1988 Jul;151(1):142-4.
  5. Teruzzi B, Salmaso A, Gerloni V, Gattinara M, Pontikaki I, Fantini F. Chronic Recurrent Multifocal Osteomyelitis (CRMO): four cases treated with aminobisphosphonate (pamidronate). Pediatr Rheumatol. 2008;6(Suppl 1):P189.
  6. Crha B, Poul J, Jochymek J. Chronic recurrent multifocal osteomyelitis. Acta Chir Orthop Traumatol Cech. 1997;64(1):35-8.
  7. Khanna G, Sato TS, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics. 2009 Jul-Aug;29(4):1159-77.
  8. Björkstén B, Boquist L. Histopathological aspects of chronic recurrent multifocal osteomyelitis. J Bone Joint Surg Br. 1980 Aug;62(3):376-80.
  9. Björkstén B, Gustavson KH, Eriksson B, Lindholm A, Nordström S. Chronic recurrent multifocal osteomyelitis and pustulosis palmoplantaris. J Pediatr. 1978 Aug;93(2):227-31.
  10. Marrero Calvo M, Merino Arribas J, Rodrigo Palacios J, Bartolomé Albistegui M, Camino Fernández A, Grande Sáez C. Chronic recurrent multifocal osteomyelitis. An Esp Pediatr. 2001 Feb;54(2):181-4.
  11.  Schilling F, Eckardt A, Kessler S.Chronic recurrent multifocal osteomyelitis. Z Orthop Ihre Grenzgeb. 2000 Nov-Dec;138(6):530-9.