Recurrent Multifocal Osteomyelitis Due to Mycobacterium avium Complex

Kourtis, Athena P.; Ibegbu, Christian; Snitzer, Joseph; Nesheim, Steven

doi:10.1093/clinids/23.5.1194

Cited by 12 publications

(9 citation statements)

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“…Multifocal osteomyelitis of proven infectious origin is mainly acute and hematogenous, albeit rare, and is caused largely by facultative bacteria that can be found in conventional bacteriological media whether solid or as enrichments. There are many citations, however, of subacute or chronic presentations of what proves to be multifocal osteomyelitis that is caused by BCG mycobacteria [90], other mycobacteria including Mycobacterium tuberculo- sis [91,92], Clostridium difficile [93], Brucella spp. [94], Coxiella burneti [95], Pseudomonas pseudomallei (melioidosis) [96], Bartonella spp.…”

Section: Chronic Infection and The Diagnostic Paradigmmentioning

confidence: 99%

Chronic multifocal osteomyelitis: Is infectious causation a moot point?

Cimolai

2011

Journal of Infection and Public Health

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Chronic multifocal osteomyelitis (CMO) is an uncommon disease entity with descriptions possibly emanating from the medical literature over one century ago, and there are numerous disease entities which have been historically detailed and which are probably synonymous. The illness is one of chronicity with exacerbating and remitting focal bony lesions. The differential diagnosis for a bony lesion which ultimately proves to be CMO is initially quite broad. There is no absolute pathognomonic clinical finding, and the diagnosis is highly dependent on clinical course, histopathology, and an absence of microbial infection. Recent studies have focused on immune dysfunction or dysregulation, and there are now many other diseases which are inflammatory in nature and which have been diagnosed among patients with CMO. Despite the aforementioned, the potential for direct infectious causation or indirect causation by infectious stimulation of immunity cannot be entirely excluded. Infection as a mechanism for pathogenesis must continue to be entertained. Multi-centre studies are key to future research.

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Section: Chronic Infection and The Diagnostic Paradigmmentioning

confidence: 99%

Chronic multifocal osteomyelitis: Is infectious causation a moot point?

Cimolai

2011

Journal of Infection and Public Health

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“…(5) Subsequently, there was increasing osteosclerosis and marked metaphyseal expansion (5) that together with soft tissue swelling seemed atypical for HPP and in keeping with CRMO. Indeed, CRMO has been reported in other conditions (29,(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62) : psoriasis, (38) palmoplantar pustulosis, (29,49) pyoderma gangrenosum, (50)(51)(52)(53) tumoral calcinosis, (51) inflammatory bowel disease, (54,56) Sweet and Majeed syndromes, (55) peripheral arthritis, (57) sacroiliitis, (59) Takayasu's arteritis, (60) and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteomyelitis). (58,61) In Japan, inflammatory oligoarthritis is reported in ;25% of CRMO patients.…”

Section: Crmo In Hppmentioning

confidence: 99%

“…(21,29,36,37) Although infection with virus, Chlamydia, mycoplasm, or other fastidious, slowgrowing organisms has been sought in CRMO, cultures for lesional pathogens are typically negative. (20)(21)(22)(23)(24)26,36,38,39) Recently, this enigmatic condition has been proposed to be an ''autoinflammatory'' disease of the skeleton. (27,28) Here, we report an unrelated boy and girl with the childhood form of HPP who developed chronic, multifocal, periarticular skeletal pain and soft tissue swelling accompanying metaphyseal expansion, radiolucencies, osteosclerosis, and BME that mimicked CRMO.…”

Section: Introductionmentioning

confidence: 99%

“…Histopathological studies show bone necrosis with nonspecific acute and chronic inflammatory cells, fibrosis, and new osseous tissue (21,29,36,37) . Although infection with virus, Chlamydia , mycoplasm, or other fastidious, slow‐growing organisms has been sought in CRMO, cultures for lesional pathogens are typically negative (20–24,26,36,38,39) . Recently, this enigmatic condition has been proposed to be an “autoinflammatory” disease of the skeleton (27,28) …”

Section: Introductionmentioning

confidence: 99%

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Chronic Recurrent Multifocal Osteomyelitis Mimicked in Childhood Hypophosphatasia

Whyte

Wenkert

McAlister

et al. 2009

Journal of Bone and Mineral Research

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Hypophosphatasia (HPP) is the inborn error of metabolism characterized by low serum alkaline phosphatase (ALP) activity caused by inactivating mutations within TNSALP, the gene that encodes the ''tissue-nonspecific'' isoenzyme of ALP (TNSALP). In HPP, extracellular accumulation of inorganic pyrophosphate, a TNSALP substrate, inhibits hydroxyapatite crystal growth leading to rickets or osteomalacia. Chronic recurrent multifocal osteomyelitis (CRMO) is the pediatric syndrome of periarticular pain and radiographic changes resembling infectious osteomyelitis but without lesional pathogens. Some consider CRMO to be an autoinflammatory disease. An unrelated boy and girl with the childhood form of HPP suffered chronic, multifocal, periarticular pain, and soft tissue swelling. To investigate this unusual complication, we evaluated their cumulative clinical, biochemical, radiological, and histopathological findings and performed mutation analysis of their TNSALP alleles. The earliest radiographic disturbances were typical of childhood HPP. Subsequently, changes consistent with CRMO developed at sites where there was pain, including lucencies, osteosclerosis, and marked expansion of the underlying metaphyses. Bone marrow edema was shown by MRI. Biopsies of affected bone showed nonspecific histopathological findings and no pathogens. The boy was heterozygous (c.1133A>T, p.D378V) and the girl compound heterozygous (c.350A>G, p.Y117C, c.400_401AC> CA, p.T134H) for different TNSALP missense mutations. Nonsteroidal anti-inflammatory drugs diminished their pain, which improved or resolved at maturity. HPP should be considered when CRMO is a diagnostic possibility. Metaphyseal radiographic changes and marrow edema associated with periarticular bone pain and soft tissue swelling suggestive of osteomyelitis can complicate childhood HPP.

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“…The axial and proximal appendicular skeleton may become infected without an apparent site of inoculation, presumably due to hematogenous spread. Osteomyelitis of the sternum due to M. abscessus or M. fortuitum has been described following open‐heart surgery, suggesting that these could also be potential pathogens in heart or heart–lung transplant patients (42, 45–48).…”

Section: Clinical Manifestationsmentioning

confidence: 99%