Chronic nonbacterial osteomyelitis and a clinical example of its successful treatmentS
Summary. Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease that most commonly affects children and adolescents, but can occur in all age groups. The clinical spectrum is variable, from asymptomatic isolated bone lesions to the most severe form, like chronic recurrent multifocal osteomyelitis (CRMO) [1–7]. CNO/CRMO is not a well-known pathology and is probably more common than is currently recognized. Due to the variable clinical presentation and nonspecific symptoms, diagnosis is often delayed or even missed. Delayed diagnosis can lead to prolonged hospitalization, intravenous antibiotics (sometimes multiple times), and multiple biopsies, which are rarely necessary for diagnosis. If untreated, this can lead to osteosclerosis, pathological fractures (mainly of the vertebral bodies) sometimes with subsequent neurological symptoms, growth abnormalities [8,9]. Radiological signs are lytic lesions, as well as osteosclerosis of varying degrees. In recent years, spinal involvement in CNO/CRMO has been increasingly reported, requiring differential diagnosis between bacterial spondylodiscitis and/or neoplasia. This article presents a clinical case of a patient who developed low back pain in adulthood. Initially, the patient was treated with NSAIDs and sulfasalazine, but due to lack of response, the patient was switched to a combination of methotrexate and prednisolone, which also had no effect. Clinical recovery was achieved after the use of bisphosphonates.
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