What's the Diagnosis? - Case 13

History 13 year old boy with elevated ESR and difficulty bearing weight on right foot.

What’s the Diagnosis - Case 13

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Findings Ultrasound demonstrates cystic lesion of the base of the fifth metatarsal that is corroborated on radiographs and MRI. Prominent associated marrow edema extending along the course of the fifth metatarsal, within the soft tissue, as well as about the calcaneal apophysis.

With interval treatment almost resolution of calcaneal apophyseal edema but new onset edema centered about the distal tibial physis.

In 1/2008, similar findings on MRI but now seen of the left foot. Again a cystic lesion (however smaller) of the fifth metatarsal base and associated pronounced edema.

Additionally, now edema pattern about both sacroiliac joints (left greater than right) as well as irregularity about both sacroiliac joints.

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Diagnosis: CRMO Chronic recurrent multifocal osteomyelitis (CRMO) is a poorly understood inflammatory process that overlaps with other inflammatory processes such as SAPHO and the seronegative arthropathies. SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is more typical of adults while CRMO predominates in children. The delineation between these syndromes is not clear at the present time. CRMO is intermittent with exacerbations and typically has a good prognosis although medical management is somewhat limited at the present.

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Diagnosis: Amyloidosis •

bonetumor.org

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ajronline.org

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jaaos.org

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What’s the Diagnosis - Case 13

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