Joana Baptista de Lima, Department of Pediatrics, Centro Materno-Infantil do Norte (CMIN), Unidade Local de Saúde de Santo António (ULSSA), Portugal
Liliana Teixeira, Department of Neonatology, Centro Materno-Infantil do Norte (CMIN), Unidade Local de Saúde de Santo António (ULSSA), Portugal
Tânia Lopes, Department of Pediatrics, Unidade Local de Saúde do Alto Minho (ULSAM), Portugal
Carla Zilhão, Department of Pediatrics, Centro Materno-Infantil do Norte (CMIN), Unidade Local de Saúde de Santo António (ULSSA); Pediatric Rheumatology Unit, Centro Materno-Infantil do Norte (CMIN), Unidade Local de Saúde de Santo António (ULSSA). Portugal
Sérgio Alves, Department of Pediatrics, Centro Materno-Infantil do Norte (CMIN), Unidade Local de Saúde de Santo António (ULSSA); Pediatric Rheumatology Unit, Centro Materno-Infantil do Norte (CMIN), Unidade Local de Saúde de Santo António (ULSSA). Portugal
Introduction: Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory disorder characterized by sterile bone inflammation, mainly affecting children. Diagnosis is challenging and delays may lead to permanent skeletal damage. Case report: An eight-year-old girl presented with a six-week history of right ankle pain, associated with nocturnal worsening, which initially improved with non-steroidal anti-inflammatory drugs but subsequently progressed to involve the left wrist. She had elevated inflammatory markers, X-rays revealed lytic bone lesions, and MRI showed a lesion suggestive of a Brodie abscess. Bone scintigraphy revealed increased uptake in the distal right tibia, left radius, and right costovertebral joint. Surgical exploration found no purulent material. Histopathology revealed subacute/chronic inflammation, and microbiological tests were negative. A diagnosis of CNO was established. Discussion: CNO should be considered in children presenting with insidious multifocal bone pain and characteristic imaging findings. Early recognition is essential to avoid unnecessary antibiotic treatments, invasive procedures, and potential long-term complications.
Keywords: Bone pain. Lytic lesions. Chronic nonbacterial osteomyelitis.
