Chronic recurrent multifocal osteomyelitis (CRMO) presenting as non-healing wound: Case report and brief Review of literature

A six year old girl child presented with delayed wound healing in her left elbow weeks after incision & drainage performed elsewhere for suspected sepsis. Radiograph revealed osteitis and osteolysis in the lower end of humerus without sequestrum. Magnetic resonance imaging ruled out possibility of any neoplastic lesion. Wound cultures were repeatedly negative for bacteria, mycobateria and fungi. There was past history of similar painful skin lesions followed by wound healing problems around the knee and the thigh. Months later she presented again with similar non-healing wound after another incision and drainage by another surgeon. Wound margin biopsy showed subacute nonspecific inflammation with prominent neutrophilic infiltration. After interdisciplinary review diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) was entertained by a diagnosis of exclusion. Due to its rarity, one may be unfamiliar with this elusive entity and a high index of suspicion is required to reduce diagnostic dilemma. Although generally a self-limiting disease, CRMO can have a prolonged course and result in significant morbidity. Immune targeted therapy helped the child heal her wound. CRMO should be considered in the differential diagnosis, once neoplasm and sepsis are excluded in recurrent inflammatory skin lesions with osteitis. This can help minimize the number of unnecessary interventions in the form of repeated biopsies, repeated debridement, surgeries and antibiotic therapy. Whenever possible, incision and drainage should be avoided in this auto inflammatory condition to avoid unpredictable course of wound healing.