Chronic mandible inflammation as the first symptom of chronic recurrent multifocal osteomyelitis (CRMO) – a case report

Abstract

Chronic recurrent multifocal osteitis (CRMO) is a rare disease of an unknown aetiology, occurring mainly in children aged 4-14 years. It is characterised by recurring episodes of osteitis, with no detectable cause, lasting from several months up to a few years. It usually affects the metaphysis of long bones. Primary lesions in the form of isolated focuses rarely occur in the mandible. The clinical symptoms of CRMO include ostealgia, soft tissue swelling (oedema), skin reddening, and mild fever. The diagnosis is difficult. It involves numerous laboratory and radiological investigations. In order to exclude infectious and neoplastic aetiology, it is advisable to perform a tissue biopsy. The disease is long-lasting with exacerbations and remissions. The prognosis is uncertain. Non-steroidal anti-inflammatory drugs and empirical antibiotic therapy are a recommended first-line therapy; if no improvement is observed, corticosteroids should be used. The analysed case concerns a 10-year-old boy with mandible inflammation as the first symptom of chronic recurrent multifocal osteitis (CRMO). Mandibular lesions may be the first symptom of chronic recurrent multifocal osteitis. The non-specific onset and variable clinical picture delay the diagnosis. Early diagnosis enables early treatment, which prevents complications.