Chronic Recurrent Multifocal Osteomyelitis of the Lower Yaw: CRMO, the Juvenile SAPHO Syndrome

Introduction: The SAPHO syndrome involves the rare disease pattern of the chronic recurrent multifocal osteomyelitis (CRMO), which mostly appears in childhood and young agers. The diagnosis delays when there is participation of the facial bones since the leading symptoms of osteomyelitis often cover up further symptoms of CRMO. The aim of the following presentation is to point out the possibility of the existence of CRMO against the background of juvenile osteomyelitis. Case Report: A 15-year-old healthy boy was admitted to our department with a swelling of his left cheek. The clinical and radiological diagnostics showed a submucosal abscess emanating from the tooth 36 associated with a vast ostitis surrounding its roots. The treatment comprised oral antibiosis, intraoral incision and extraction of the tooth throughout the sub-acute interval. After 4 weeks, the boy presented further complains caused by an obviously interrupted wound healing. The computer tomography of the lower yaw and the bone scintigram displayed the probable cause for this; namely an osteomyelitis. A probe of tissue taken from the inflammated area confirmed the diagnosis. Consulting the pediatric and dermatologic department, the diagnosis of CRMO could be denominated by the implementation of the existence of acne and pustulosis. The following treatment included a corticoid-pulse-therapy. Since then, the patient did not show further discomfort or relapse. Conclusion: The development of an interrupted wound healing like osteomyelitis in juvenile patients needs enhanced treatment, involving different medical departments. In particular, CRMO has to be taken into account for diagnosis determination. Keywords: CRMO, SAPHO, corticoid-pulse-therapy