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

[Boyce, Thomas G., M.D.]

Does he have any GI symptoms?  CRMO is more common in patients with Crohn's disease.  I usually treat CRMO with scheduled indomethacin or naprosyn (while continuing to be vigilant for possible infectious causes, especially in a patient with CGD).  Clinical response to NSAIDS is presumptive evidence for CRMO (although it waxes and wanes on its own as well).


Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
email: boyce.thomas at mayo.edu
phone: 507-255-8464
fax: 507-255-7767


From: Pere Soler Palacin [mailto:psoler at vhebron.net]
Sent: Thursday, February 20, 2014 10:28 AM
To: CIS-PIDD
Cc: Mai Figueras
Subject: [cis-pidd] Multifocal osteomyelitis in an eleven yo boy with CGD


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<mailto:psoler at vhebron.net>; 34660psp at comb.cat<mailto:34660psp at comb.cat>. Web: www.upiip.com<http://www.upiip.com/>.



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