A 9-year-old girl has recurrent episodes of multifocal bone pain with fever over 2 years. Imaging shows lytic lesions in the clavicle, distal femur, and calcaneum. Cultures are repeatedly sterile, biopsies show chronic inflammatory infiltrate without organisms, she fails multiple antibiotic courses, and her lesions resolve with naproxen. The most likely diagnosis is:

• A Metastatic neuroblastoma
• B Multifocal tuberculous osteomyelitis
• C Langerhans cell histiocytosis
• D Chronic recurrent multifocal osteomyelitis ✓

Explanation

Chronic recurrent multifocal osteomyelitis is a non-infectious autoinflammatory disorder of children presenting with episodic multifocal aseptic bone lesions, a predilection for the clavicle and metaphyses of long bones, sterile cultures, and response to nonsteroidal anti-inflammatory drugs rather than antibiotics. Failure of repeated antibiotic courses with sterile biopsy distinguishes it from true infection, and the clavicular involvement is highly suggestive.

Reference: Tachdjian's Pediatric Orthopedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.