Abril - 2017

ueiroz

306

ssoc

ras

2017; 63(4):303-306

rounding sclerosis. There is also the possibility of progres-

sion with locoregional cortical hyperostosis, in addition

to simple, solid or multilamellar laminar periosteal reac-

tion (7-48%), which may be the most obvious alteration

in long and diaphyseal bones. Edema in bones and sur-

rounding soft parts is usually present.

1,4-6

Jansson et al. proposed the diagnosis of CRMO based

on criteria, being positive if two major or one major and

three minor criteria are met,

1,2,7,8

as follows:

•

Major criteria – osteolytic/sclerotic lesions evident in

imaging tests; multifocal bone lesions; presence of pal-

moplantar pustulosis or psoriasis; sterile bone biop-

sies with signs of inflammation and/or sclerosis.

1,2,7,8

•

Minor – normal blood count and leukogram; good

general health; discrete/moderate elevation of ESR

and CRP; disease course greater than 6 months; hy-

perostosis; association with other autoimmune di-

seases besides psoriasis and palmoplantar pustulo-

sis; first or second degree relative with autoimmune

or autoimmune disease.

1,2,7,8

The most widely used treatment with the best results is

nonsteroidal anti-inflammatory drugs (NSAIDs). Other

therapeutic possibilities include the use of steroids,

methotrexate, sulfasalazine, bisphosphonates, infliximab,

colchicine, hyperbaric oxygen therapy, alpha and gamma

interferons.

1,2,4-11

CRMO is not usually lethal, but at least 20% of cases

develop with sequelae. Chronic pain, pathological fractures,

growth deformities, focal increase of bone volume, col-

lapse in varying degrees of vertebral bodies with repercus-

sion in the spinal canal are some of the possible compli-

cations, the latter being more serious.

1,4-6

esumo

Osteomielite crônica multifocal recorrente exibindo pre-

domínio de reação periosteal

Osteomielite crônica multifocal recorrente é uma desor-

dem autoinflamatória óssea idiopática não piogênica,

envolvendo vários sítios e com evolução clínica persistin-

do por mais de 6 meses, podendo apresentar episódios

de remissão e exacerbação em longo prazo. Representa

de 2 a 5% das osteomielites, com incidência aproximada

de até 4/1.000.000, com idade média de apresentação

estimada entre 8 e 11 anos, predominando no gênero

feminino. Os membros inferiores são os mais afetados,

com predileção para regiões metafisárias junto à fise. Des-

crevemos um caso da doença em uma menina de 2 anos

e 5 meses de idade, com acometimento de ulna esquerda,

mandíbula à direita e tíbia esquerda, exibindo predomínio

de reação periosteal como achado principal.

Palavras-chave:

osteomielite, crônica, multifocal, recor-

rente, periosteal.

eferences

Jansson A, Renne ED, Ramser J, Mayer A, Haban M, Meindl A, et al.

Classification of non-bacterial osteitis: retrospective study of clinical,

immunological and genetic aspects in 89 patients. Rheumatology (Oxford).

2007; 46(1):154-60.

2. Campos TA, Rebelo J, Maia A, Brito I. Osteomielite multifocal crónica

recorrente: uma entidade a reconhecer!. Arq Med. 2011; 25(5-6):183-5.

3. Guerra JG, Lima FAC, Macedo LMG, Rocha AAL, Fernandes JF. [SAPHO

syndrome: rare or under-diagnosed?] Radiol Bras. 2005; 38(4):265-71.

von Kalle T, HeimN, Hospach T, Langendörfer M, Winkler P, Stuber T. Typical

patterns of bone involvement in whole-body MRI of patients with chronic

recurrent multifocal osteomyelitis (CRMO). RoFo. 2013; 185(7):655-61.

Falip C, Alison M, Boutry N, Job-Deslandre C, Cotten A, Azoulay R, et al.

Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case

series review. Pediatr Radiol. 2013; 43(3):355-75.

Fritz J, Tzaribatchev N, Claussen CD, Carrino JA, Horger MS. Chronic

recurrent multifocal osteomyelitis: comparison of whole-body MR imaging

with radiography and correlation with clinical and laboratory data. Radiology.

2009; 252(3):842-51.

7. Tlougan BE, Podjasek JO, O’Haver J, Cordova KB, Nguyen XH, Tee R, et al.

Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne,

pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with associated

neutrophilic dermatoses: a report of seven cases and review of the literature.

Pediatr Dermatol. 2009; 26(5):497-505.

Ferraria N, Marques JG, Ramos F, Lopes G, Fonseca JE, Neves MC.

Osteomielite crónica multifocal recorrente: série de 4 casos clínicos tratados

com bifosfonatos. Acta Reumatol Port. 2014; 39(1):38-45.

Stern SM, Ferguson PJ. Autoinflammatory bone diseases. Rheum Dis Clin

North Am. 2013; 39(4):735-49.

10.

Paim LB, Liphaus BL, Rocha AC, Castellanos AL, Silva CA. [Chronic recurrent

multifocal osteomyelitis of the mandible: report of three cases]. J Pediatr

(Rio J). 2003; 79(5):467-70.

11.

Machado LG, Capp AA, Paes MAS, Oliveira RB, Bonfante HL. [Pamidronate

treatment in SAPHO syndrome]. Rev Bras Reumatol. 2005; 45(6):409-12.

12. Teixeira SR, Elias Junior J, Nogueira-Barbosa MH, Guimarães MD, Marchiori

E, Santos MK. Whole-body magnetic resonance imaging in children: state

of the art. Radiol Bras. 2015; 48(2):111-20.