Chronic recurrent multifocal osteomyelitis. A narrative and pictorial review

Front Immunol. 2022 Aug 22:13:959575. doi: 10.3389/fimmu.2022.959575. eCollection 2022.


Chronic recurrent and multifocal osteomyelitis (CRMO) is a nonsporadic autoinflammatory disorder. Currently, it is diagnosed based on clinical, radiologic, pathological, and longitudinal data. Numerous aspects should be highlighted due to increased knowledge in imaging and immunology. We emphasize the use of whole-body MRI, which is a non-invasive diagnostic strategy. A literature review was carried out on longitudinal studies. Commonly, the mean age at diagnosis is 11 years, ranging between 3 and 17. The most common sites are the long bone metaphysis, particularly femoral and tibial metaphysis. In addition, the pelvis, spine, clavicle, and mandible may be involved. In long bones, the radiologic appearance can show typical structure, mixed lytic and sclerotic, sclerotic or lytic. It is frequently metaphyseal or juxta-physeal, with hyperostosis or periosteal thickening. The involvement of the vertebral skeleton is often multifocal. Therefore, whole-body MRI is essential in identifying subclinical lesions. CRMO is a polymorphic disorder in which whole-body MRI is beneficial to demonstrate subclinical edema. Vertebral collapse requires long-term monitoring.

Keywords: autoinflammatory; bone; chronicity; multilaterality; osteomyelitis.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone and Bones / pathology
  • Child
  • Humans
  • Longitudinal Studies
  • Magnetic Resonance Imaging / methods
  • Osteomyelitis* / diagnostic imaging
  • Osteomyelitis* / pathology

Supplementary concepts

  • Chronic recurrent multifocal osteomyelitis