Abstract：
Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder characterized by non-bacterial osteomyelitis causing recurrent multifocal bone lesions, is a well-known, yet uncommon pediatric condition that rarely affects adults; to date, it has never been diagnosed over the age of 75. The following report will discuss the first octogenarian diagnosed with CRMO and therefore represents an exceptionally rare presentation of a rare disease. An 83-year-old woman presented with progressive right shoulder, forearm, and hip pain, with associated weight loss and global weakness, requiring a wheelchair for mobility. Imaging revealed a pathologic right ulna fracture in addition to lytic lesions of the right proximal humerus and proximal femur. The clinical picture was thus that of a patient with probable multiple myeloma versus metastatic disease. After an extensive workup, however, the lesions were not malignant; histologic findings were instead suggestive of chronic osteomyelitis with negative cultures. Given the multifocal nature of this condition, combined with a lack of clinical symptoms of infection, a diagnosis of CRMO was rendered. The patient underwent intramedullary nailing of the right femur and splinting of the ulna, with a subsequent remarkable recovery to painless ambulation, complete union of the right ulna fracture, and resolution of the lytic lesions without receiving any targeted medical treatment. This case highlights the importance of maintaining CRMO on the differential for multifocal skeletal lesions, regardless of age. Performing a thorough workup with necessary imaging, biopsy, and culture are critical to establishing this diagnosis, which can only made as a diagnosis of exclusion.
摘要：
慢性复发性多灶性骨髓炎（CRMO），一种自身炎症性骨病，以非细菌性骨髓炎引起复发性多灶性骨病变为特征，是一个众所周知的，然而罕见的儿科疾病，很少影响成年人；迄今为止，它从未被诊断超过75岁。以下报告将讨论第一位被诊断患有CRMO的八十岁老人，因此代表了一种罕见疾病的罕见表现。一名83岁的女性右肩进展，前臂,髋部疼痛,伴随着体重减轻和全球疲软，需要轮椅才能移动。影像学显示，除了右肱骨近端和股骨近端的溶解性病变外，还有病理性的右尺骨骨折。因此，临床表现是患有可能的多发性骨髓瘤与转移性疾病的患者。经过广泛的检查，然而,病变不是恶性的;组织学检查结果提示慢性骨髓炎,培养阴性.鉴于这种情况的多焦点性质，加上缺乏感染的临床症状，诊断为CRMO。患者接受了右股骨髓内钉和尺骨夹板，随后显着恢复到无痛行走，右尺骨骨折完全愈合,在没有接受任何针对性药物治疗的情况下，溶解性病变的解决。该病例强调了维持CRMO对多灶性骨骼病变差异的重要性，不管年龄。用必要的成像进行彻底的检查，活检,和文化对于建立这种诊断至关重要，这只能作为排除的诊断。
