Bone scintigraphy in diagnosing chronic recurrent multifocal osteomyelitis

A 10-year-old boy was referred to us for evaluation of FUO accompanied with bone pain in both calves. Three hours after intravenous injection of 13 mCi of 99mTc-MDP, whole body scan in multiple spot views was performed. The scan showed symmetrical areas of diffusely increased tracer uptake in multiple long bones. Histopathologic evaluation confirmed osteosclrosis and fibrotic changes without any bacterial growth in the specimen culture. Based on patient’s history, lab results, bone scan and histopathologic findings, chronic recurrent multifocal osteomyelitis (CRMO) was considered as the most likely diagnosis. Dramatic response to NSAIDs and pamidronate therapy confirmed the diagnosis of CRMO.