CHRONIC NON-INFECTIVE OSTEOMYELITIS OF THE LEFT CLAVICLE IN A 12-YEAR-OLD BOY: A CASE STUDY

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Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic condition characterized by foci of sterile bone inflammation and prolonged, self-limiting and recurrent course. We describe a case of a 12-year-old boy with several months lasting pain and aggravated morphological abnormality of the left clavicle. Based on computer tomography scan and magnetic resonance imaging, the patient was initially highly suspected of having a neoplastic process. However, open biopsy and pathohistological examination of the resected specimen showed chronic inflammatory components with fibrosis, with no signs of neoplastic disease which set the final diagnosis of unifocal CNO of the left clavicle. Although the clavicle is considered a typical site of CNO, isolated involvement of the clavicle without recurrences, as in our patient, is rarely reported and could delay the diagnosis. The patient was treated with Naproxen (15 mg/kg/day) and experienced complete resolution of the symptoms after few months of treatment. During the two years of follow-up, the patient did not have new flares of the disease. CNO is diagnosis of exclusion, and a high level of suspicion is paramount in atypical cases to avoid unnecessary biopsies and repeated antibiotic regimens.

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