Use of infliximab in patient with chronic non-bacterial osteomyelitis, case report
Uso de infliximab en paciente con osteomielitis crónica no bacteriana, reporte de caso
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Introduction: chronic non-bacterial osteomyelitis (CNO) is a non-infectious inflammatory of unknown etiology. Case description: ABA, female, 16 years old, was admitted with a pain in her left thigh. At the time, it was suspected to be caused by a tumor, and a bone scintigraphy was requested, which evidenced a focal area of increased uptake in the distal metadiaphyseal area of the left femur. A bone biopsy was performed, and its result was compatible with chronic osteomyelitis. The patient started taking pamidronate (withdrawn due to treatment failure) and methotrexate (subsequently suspended due to urticarial reaction). After some years of clinical stability, a new focal area of osteomyelitis appeared, in the distal right femur. The use of anti-TNF (infliximab) was chosen, resulting in an improvement of the algic state. Discussion: the diagnosis of CNO is made by process of elimination and is based on clinical, laboratorial, radiological, bacteriological and histological data. Non-hormonal anti-inflammatory and bisphosphonate drugs are recommended as initial therapy. Disease-modifying drugs, steroids and anti-TNFα have been used in severe and recurring cases. Conclusion: the authors present a CNO case with good response to anti-TNFα after treatment failure with bisphosphonates.
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- Beck C, Morbach H, Beer M, Stenze M, Tappe D, Gattenlohner S, et al. Chronic nonbacterial osteomyelitis in child: prospective follow-up during the first year of anti-inflammatory treatment. Arthritis Res Ther 2010; 12(2):R74. DOI: 10.1186/ar2992.
- Jansson AF, Müller TH, Gliera L, Ankerst DP, Wintergerst U, Belohradsky BH, et al. Clinical score for nonbacterial osteitis in children and adults. Arthritis Rheum 2009; 60(4):1152-9. DOI: 10.1002/art.24402.
- Girschick HJ, Zimmer C, Klaus G, Darge K, Dick A, Morbach H. Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol 2007; 3:733-738. DOI: 10.1038/ncprheum0653.
- Taddio A, Ferrara G, Insalaco A, Pardeo M, Gregori M, Finetti M, et al. Dealing with Chronic Non-Bacterial Osteomyelitis: a practical approach. Pediatr Rheumatol Online J 2017; 15(1):87. DOI:10.1186/s12969-017-0216-7.
- Giedion A, Holthusen W, Masel LF, Vischer D. Subacute and chronic “symmetrical” osteomyelitis. Ann Radiol (Paris) 1972; 15(3):329-42.
- Cox AJ, Zhao Y, Ferguson PJ. Chronic Recurrent Multifocal Osteomyelitis and Related Diseases – Update on Pathogenesis. Curr Rheumatol Rep 2017; 19:18. DOI:10.1007/s11926-017-0645-9
- Hofmann SR, Kapplusch F, Girschick HJ, Morbach H, Pablik J, Ferguson PJ, et al. Chronic Recurrent Multifocal Osteomyelitis (CRMO): Presentation, Pathogenesis, and Treatment. Curr Osteoporos Rep. 2017; 15(6):542-54. DOI:10.1007/s11914-017-0405-9.
- Paim LB, Liphaus BL, Rocha AC, Castellanos ALZ, Silva CAA. Osteomielite crônica multifocal recorrente da mandibular: relato de 3 casos. J Pediatr (Rio J.) 2003; 79(5):467-70. DOI:10.1590/S0021-75572003000500016.
- Ferraria N, Marques JG, Ramos F, Lopes G, Fonseca JE, Neves MC. Osteomielite crônica multifocal recorrente: série de quatro casos clínicos tratados com bifosfonados. Acta Reumatol Port 2014; 39:38-45.
- Jansson A, Renner ED, Ramser J, Mayer A, Haban M, Meindl A, et al. Classification of Non-Bacterial Osteitis. Reumatology 2007; 46:154-160. DOI: 10.1093/rheumatology/kel190.
- Girschick H, Finetti M, Orlando F, Schalm S, Insalaco A, Ganser G, et al. The multifaceted presentation of chronic recurrent multifocal osteomyelitis: a series of 486 cases from the Eurofever international registry. Rheumatology (Oxford) 2018; DOI: 10.1093/rheumatology/key058.
- Moussa T, Bhat V, Kini V, Fathalla BM. Clinical and genetic association, radiological findings and response to biological therapy in seven children from Qatar with non-bacterial osteomyelitis. Int J Rheum Dis 2017; 20(9):1286-1296. DOI: 10.1111/1756-185X.12940.
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