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Age / Sex : 13 / M
Chief complaint: recurrent pain & swelling at the right ankle 1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.) Courtesy: 추혜정(Hye Jung Choo), 인제대부산백병원(Inje University Busan Paik Hospital)
Diagnosis: Chronic recurrent multifocal osteomyelitis
Discussion
Findings:
Fig. 1
Simple radiographies of the ankle show the metaphyseal erosions at the distal
tibia and fibula (taken 15 months before).
Fig. 2
Sagittal MR images show the metaphyseal erosions with extension to the growth
plates of the distal tibia and fibula (taken 15 months before).
Fig. 3
Simple radiographies of the ankle show the normalization of the bony erosion at
the distal tibia and fibula (taken 11 months before).
Fig. 4
Simple radiographies of the ankle show the recurrent bony erosion and mild sclerotic
change at the metaphyses of the distal tibia and fibula.
Differential Diagnosis: Osteomyelitis
Diagnosis:
Chronic recurrent multifocal osteomyelitis
Discussion:
¢ Autoinflammatory disorder of bone
with fever, multifocal painful nonpyogenic bone lesions, in children and
adolescents
¢ Adult disease is SAPHO syndrome
(synovitis, acne, pustulosis, hyperostosis, osteitis)
¢ Unknown etiology
— Widely held hypothesis: noninfectious
inflammatory disorder
— Pathogens are generally not cultured
¢ Clinical features
— Nonspecific complaints: pain,
tenderness, swelling, or limited range of motion at one or more sites
— Systemic manifestations: fever,
weight loss, and lethargy
— Mildly elevated ESR and CRP
— Duration of symptoms: vary from days
to several years
¢ Imaging features
— Long tubular bones and clavicle (m/c
site)
¢
Lower
extremity > upper extremity (more than three times)
¢
Tibia (m/c
bone), metaphyses (m/c)
References:
1.
Khanna G,
Sato TS, Ferguson P. Imaging of Chronic Recurrent Multifocal Osteomyelitis. RadioGraphics
2009; 29:1159–1177
2.
Iyer RS, Thapa MM, Chew FS. Chronic
recurrent multifocal osteomyelitis: review. AJR 2011; 196:S87–S91
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