[CIS PIDD] [cis-pidd] Multifocal osteomyelitis in an eleven yo boy with CGD

[Pere Soler Palacin]

Dear all we have a 11 yo male with XL-CGD with multifocal ostemyelitis unresponsive to antibiotic therapy. 

The patient presented with mild pain of his right pelvic area almost two months ago (he was doing previously well). At that point MRI, Tc-scintigraphy and bone biopsy were performed: MRI was compatible with acute osteomyelitis, scintigraphy showed two focus (right pelvis and right knee) and bone biopsy showed PMN infiltration but cultures (B, MB, fungus) and both panfungal and 16sRNA PCRs were negative. IV meropenem was instituted at that point and the patient clinically improved with acute phase reactants lowering too. 

However, 3 weeks later APR increased again and the patient presented with knee pain. Once again, a MRI was performed and showed a new focus on the contralateral acetabulum. Bone biopsy was performed with negative results again. Tc- scintigraphy was compatible with multifocal osteomielytis affecting the jaw and several metaphyseal bones of both the upper and lower limbs despite the patient did not described any simptoms at that level. Scintigraphy with marked leucocytes revealed signs of inflammation at the initial focus but showed cold lesions in all the other affected bones. Ecocardiogram ruled IE out. 

Serological studies to Bartonella spp, Coxiella burnetti, Leishmania spp and Brucella spp were negative. Long-term cultures are still on going but no microorganism has grew yet. 



Do you have any experience with aseptic meningitis in CGD patients? CRMO?  Any other suggestion? 



Thanks in advance. 



Pere. 




Pere Soler Palacín, MD, PhD. 
Pediatric Infectious Diseases and Immunodeficiencies Unit. Hospital Universitari Vall d'Hebron.     
Assistant Professor. Universitat Autònoma de Barcelona.                                                       
Passeig de la Vall d'Hebron 119-129. 
08035 Barcelona. Spain. 
Tel: 0034934893140. Fax: 0034934893039. 
E-mail: psoler at vhebron.net ; 34660psp at comb.cat . Web: www.upiip.com . 

  

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Pere Soler Palacín, MD, PhD. 
Pediatric Infectious Diseases and Immunodeficiencies Unit. Hospital Universitari Vall d'Hebron.     
Assistant Professor. Universitat Autònoma de Barcelona.                                                       
Passeig de la Vall d'Hebron 119-129. 
08035 Barcelona. Spain. 
Tel: 0034934893140. Fax: 0034934893039. 
E-mail: psoler at vhebron.net ; 34660psp at comb.cat . Web: www.upiip.com . 

  

No imprimir aquest correu ajudarà a preservar el medi ambient. 
Si vostè no és el destinatari del missatge, o l'ha rebut per error, si us plau notifiqui-ho al remitent i destrueixi el missatge amb tot el seu contingut. Està prohibida la distribució no autoritzada del contingut d'aquest missatge. 

No imprimir este correo ayudará a preservar el medio ambiente. 
Si usted no es el destinatario del mensaje, o lo ha recibido por error, notifíquelo por favor al remitente y destruya el mensaje con todo su contenido. Está prohibida la distribución no autorizada del contenido de este mensaje. 


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