AccScience Publishing / TD / Online First / DOI: 10.36922/td.3102

Chronic recurrent multifocal osteomyelitis masquerading as multifocal bone Langerhans cell histiocytosis in children: A case series from a tertiary cancer center

Yamini Krishnan1* Gazel Sainulabdin1 V. P. Krishnan1 N. T. K. Thanseer2
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1 Department of Paediatric Haematology, Oncology and Bone Marrow Transplantation, MVR Cancer Centre and Research Institute, Calicut, Kerala, India
2 Department of Nuclear Medicine, MVR Cancer Centre and Research Institute, Calicut, Kerala, India
Tumor Discovery, 3102
Submitted: 6 March 2024 | Accepted: 28 May 2024 | Published: 19 June 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Chronic recurrent multifocal osteomyelitis (CRMO), also known as chronic non-bacterial osteomyelitis (CNO), is an autoimmune inflammatory bone disorder mainly affecting children and adolescents. The clinical presentation varies from mild, self-limiting unifocal bone inflammation, which is more common, to multifocal recurrent disease. CRMO can be misdiagnosed as multifocal bone Langerhans cell histiocytosis (LCH), infections, lymphoma, or metabolic bone disease. Clinical features are highly variable and not very specific. Most children experience vague aches and pains over prolonged periods but remain generally well and do not exhibit growth failure. In this article, we describe a case series of three children who presented with multifocal bone disease and were initially referred for LCH; however, detailed investigations confirmed the diagnosis of CRMO. The treatment options included non-steroidal anti-inflammatory drugs, corticosteroids, and disease-modifying anti-rheumatic drugs. Other treatment options included anti-tumor necrosis factor agents and bisphosphonates, similar to those used for autoimmune bone diseases. CRMO should be considered a differential diagnosis in children presenting with chronic, vague, and recurrent bony symptoms with or without systemic symptoms.

Chronic recurrent multifocal osteomyelitis
Langerhans cell histiocytosis
Chronic non-bacterial osteomyelitis
Multifocal bone disease
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Conflict of interest
The authors declare no conflicts of interest.
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Tumor Discovery, Electronic ISSN: 2810-9775 Published by AccScience Publishing