UNASSIGNED: A 9-year-old girl presented bilateral shoulder inequality with pain in the left hypochondrium for 2 months. Standing spinal x-rays showed right convex scoliosis with a 25° Cobb angle. Chest magnetic resonance imaging (MRI) showed that the T8 vertebra was flattened and local bone was destroyed with bone marrow edema. The bone biopsy showed evidence of fibrosis and chronic inflammatory changes with no specific diagnosis. One month later, her scoliosis and bone destruction deteriorated obviously. Thoracic vertebra MRI showed that the T8 vertebra had a compression fracture. 99mTc-MDP whole-body bone scintigraphy showed intense uptake at T8/9 and the right sacroiliac joint. She was diagnosed with CNO accompanied by rapidly progressive scoliosis. The scoliosis was successfully treated with adalimumab and zoledronic acid, which showed significant improvement after 6 months of follow-up.
UNASSIGNED: Zoledronic acid and adalimumab successfully treated CNO with rapidly progressive scoliosis, but could not prevent vertebral compression.
■一名9岁的女孩出现双侧肩不平等,左下软骨疼痛2个月。站立脊柱X线显示右侧凸性脊柱侧凸,Cobb角为25°。胸部磁共振成像(MRI)显示T8椎骨变平,局部骨骼破坏,骨髓水肿。骨活检显示纤维化和慢性炎症改变的证据,没有特异性诊断。一个月后,她的脊柱侧弯和骨质破坏明显恶化。胸椎MRI显示T8椎体压缩性骨折。99mTc-MDP全身骨闪烁显像在T8/9和右骶髂关节显示强烈摄取。她被诊断患有CNO并伴有快速进行性脊柱侧弯。脊柱侧凸用阿达木单抗和唑来膦酸成功治疗,随访6个月后显示显着改善。
唑来膦酸和阿达木单抗成功治疗了快速进行性脊柱侧凸的CNO,但不能防止椎体压缩。