A rare adult presentation of chronic recurrent multifocal osteomyelitis (CRMO) in 38-year female with exclusive spinal involvement

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, autoinflammatory bone disorder most often seen in children and adolescents characterized by recurrent episodes of sterile osteolytic osseous lesions. Diagnosing CRMO requires the exclusion of other conditions, which is often challenging due to its varied presentations and progression. However, adult-onset CRMO and exclusive spinal cases are extremely rare events, highlighting the importance of this case. Our case presents a 38-year-old female with chronic back pain for 6 months of postepidural anesthesia during a C-section. The pain was progressive, exacerbated by movement, and partially relieved by painkillers. The patient had tenderness on physical examination in the thoracolumbar region. MRI of the spine showed multiple endplate changes, and extensive laboratory tests and biopsy ruled out infectious cause and malignancy, leading to the diagnosis of CRMO. The connection between pain and epidural anesthesia was only an incidental finding. The patient was treated effectively with steroids and etanercept. CRMO is mainly a childhood disease, with adult cases being very rare. Isolated spinal involvement in CRMO is particularly rare and can make the diagnosis challenging. This case highlights that CRMO should be considered in adults with an atypical isolated spinal lesion. NSAIDs are the main treatment, with corticosteroids and TNF inhibitors used in unresponsive cases. This case underscores the need for heightened awareness of CRMO's potential to present in adults with atypical isolated spinal lesions, which could lead to more timely and accurate diagnoses.

Keywords

• Adult-onset
• Sterile osteolytic lesions
• CRMO diagnosis