A 10-year-old girl presents with recurrent episodes of bone pain over 2 years involving the clavicle, distal femur and calcaneum. Each episode features low-grade fever, elevated ESR and CRP, and MRI showing marrow oedema with periostitis. Cultures are repeatedly sterile, biopsies show nonspecific chronic inflammation, and she has palmar pustulosis. What is the most likely diagnosis?

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

Explanation

Chronic recurrent multifocal osteomyelitis is a sterile autoinflammatory osteomyelitis of children that preferentially affects the clavicle, metaphyses of long bones and small bones, often associated with psoriasis or palmar pustulosis as part of the SAPHO spectrum. The combination of multifocal relapsing lesions, repeatedly negative cultures and nonspecific histology excludes bacterial osteomyelitis, while the age, distribution and inflammatory course distinguish it from Langerhans cell histiocytosis and neuroblastoma.

Reference: Nelson Textbook of Pediatrics, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.