Chronic recurrent multifocal osteomyelitis of the mandible: report of three cases

Paim, Luciana B.; Liphaus, Bernadete L.; Rocha, André Caroli; Castellanos, Aura L. Z.; Silva, Clóvis A.

doi:10.2223/jped.1082

Cited by 9 publications

(13 citation statements)

References 8 publications

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“…18 It has been suggested that there may be a relationship between primary chronic osteomyelitis of the mandible (including cases attributable to Actinomyces) and chronic, recurrent, multifocal osteomyelitis (CRMO) 19 or the synovitis, acne, pustulosis, hyperostosis, osteitis syndrome variant. 20 Cases of CRMO with bilateral mandibular involvement, without involvement of other bones, have been described. 20 Chronic osteomyelitis of the mandible and CRMO are both characterized by multiple recurrences and inconsistent responses to antimicrobial treatment.…”

Section: Discussionmentioning

confidence: 99%

“…20 Cases of CRMO with bilateral mandibular involvement, without involvement of other bones, have been described. 20 Chronic osteomyelitis of the mandible and CRMO are both characterized by multiple recurrences and inconsistent responses to antimicrobial treatment. Cultures of bone are usually sterile in CRMO, but it is possible that mandibular cultures that grow Actinomyces are sometimes contaminated.…”

Section: Discussionmentioning

confidence: 99%

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Actinomycosis Presenting as Osteomyelitis in the Pediatric Population

Robinson¹,

Vaudry²,

Dobrovolsky³

2005

Pediatric Infectious Disease Journal

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Osteomyelitis attributable to Actinomyces often results in recurrent disease and inconsistent responses to antimicrobial agents. We present data for 4 patients and a review of the 15 previously described pediatric cases of actinomycosis presenting as osteomyelitis. Fourteen cases involved the mandible and 5 cases involved other sites. All mandibular cases required at least 1 debridement, with 4 of the cases requiring multiple debridements.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Actinomycosis Presenting as Osteomyelitis in the Pediatric Population

Robinson¹,

Vaudry²,

Dobrovolsky³

2005

Pediatric Infectious Disease Journal

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“…It is basically a benign fibro-osseous lesion that has to be distinguished from other similar lesions like Chronic sclerosing osteomyelitis, Fibrous dysplasia, Ossifying fibroma, and Paget's disease based on combined clinical, radiographic, and histological features , Jong-Ki et al 2013). Chronic sclerosing osteomyelitis which is primarily an inflammatory condition of the jaws usually present with cyclic episodes of remissions and exacerbations, associated with unilateral pain, swelling and most often shows a single area of diffuse sclerosis containing small, ill-defined osteolytic areas (Paim et al 2003). Whereas, florid cemento-osseous dysplasia is evident as lobulated opaque masses which is often surrounded by a characteristic radiolucent border and is evident in all the quadrants symmetrically.…”

Section: Discussionmentioning

confidence: 99%

Florid Cemento-Osseous dysplasia - A hidden inquest

Dathar

Kiran

Tatapudi

et al. 2015

IJM

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<p>Florid cemento-osseous dysplasia (FCOD) is a rare distinguishable condition that characteristically affects the jaws of middle aged women. It is usually symmetrical on both sides and manifests radiographically as diffuse, lobulated multiple sclerotic radio-opacities involving all the quadrants of the jaws. The lesion is mostly benign and requires no treatment unless the patient is symptomatic. For the asymptomatic patient the best management advisable is regular recall checkups and reinforcement of good oral hygiene. Herewith, we are reporting one such rare entity of a 37 year old female patient.</p>

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“…Typically, the levels of complement components (C3 and C4), IgA and IgM do not change. 1,5,7,8,10 HLA-27 is positive in less than 30% of the patients. 1,9,11 Performing a biopsy is important to rule out other diagnostic hypotheses.…”

mentioning

confidence: 93%

“…Histological findings are nonspecific and often similar to those found in septic osteomyelitis, but with no evidence of infection by any microorganism. 1,[2][3][4][5][6][7][8][9][10] Imaging tests such as radiography, CT, magnetic resonance imaging (MRI) and scintigraphy are some of the diagnostic tools. The latter two are most commonly used to rule out other diseases and to detect asymptomatic sites employing whole body screening techniques.…”

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confidence: 99%

Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction

Queiroz¹,

Rocha²,

Lauar

et al. 2017

Rev. Assoc. Med. Bras.

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Chronic recurrent multifocal osteomyelitis is an idiopathic nonpyogenic autoinflammatory bone disorder involving multiple sites, with clinical progression persisting for more than 6 months and which may have episodes of remission and exacerbation in the long term. It represents up to 2-5% of the cases of osteomyelitis, with an approximate incidence of up to 4/1,000,000 individuals, and average age of disease onset estimated between 8-11 years, predominantly in females. The legs are the most affected, with a predilection for metaphyseal regions along the growth plate. We describe the case of a female patient, aged 2 years and 5 months, with involvement of the left ulna, right jaw and left tibia, showing a predominance of periosteal reaction as main finding.Keywords: osteomyelitis, chronic, multifocal, recurrent, periosteal.case report A female patient aged 2 years and 5 months, being investigated due to pain and swelling in the left forearm for one month. Her parents denied episodes of fever, trauma, and other comorbidities. On physical examination, the child presented normal weight, normal skin color, she was well-hydrated, acyanotic, breathing normally and in good general conditions. Blood counts analyzed in the previous month revealed mild leukocytosis and normocytic normochromic anemia. Levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were slightly elevated.Computed tomography (CT) of the left forearm without intravenous contrast revealed a periosteal reaction and a small area of loss of cortical compaction, especially in the ulna ( Figure 1A).A biopsy of the left ulna was performed with results describing signs suggestive of chronic osteomyelitis. Culture of the biopsy material did not show growth of microorganisms.Empirical antibiotic therapy was used starting one month after diagnosis, but there was no change in clinical status. A new biopsy was performed in the third month, showing the same findings associated with negative blood culture. Radiographs of the left forearm from the second to the fifth month showed progression of the multilamellar periosteal reaction to a solid type ( Figure 1B).Chest radiography, echocardiography, levels of TSH, T4, IgG, IgA, IgM and complement components were all normal. A hypothesis of chronic recurrent multifocal osteomyelitis (CRMO) was suggested and thus treated with ibuprofen combined with methotrexate, later replaced with sulfasalazine.Between the eighth and ninth month, pain and swelling appeared in the right mandibular region and in the left leg. A facial CT scan showed mainly periosteal reaction at the right mandibular angle with mild bone sclerosis (Figure 2). CT scan of the left leg also characterized a periosteal reaction in the tibial diaphysis with a small area of cortical alteration (Figure 3), similar to that found in the ulna.After 6 months of therapy, there was clinical and general laboratory improvement, with left forearm radiography in the 11 th month showing a regression of the periosteal reaction, despite persistence of corti...

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Chronic recurrent multifocal osteomyelitis of the mandible: report of three cases

Cited by 9 publications

References 8 publications

Actinomycosis Presenting as Osteomyelitis in the Pediatric Population

Actinomycosis Presenting as Osteomyelitis in the Pediatric Population

Florid Cemento-Osseous dysplasia - A hidden inquest

Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction

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