# Chronic Recurrent Multifocal Osteomyelitis Associated in a Child with Inflammatory Bowel Disease and Primary Sclerosing Cholangitis: A Case Report

## TL;DR

A 14-year-old boy with inflammatory bowel disease and primary sclerosing cholangitis developed chronic recurrent multifocal osteomyelitis, highlighting the need for early diagnosis to avoid unnecessary antibiotics.

## Contribution

This case report presents a rare co-occurrence of CRMO with both IBD and PSC in a pediatric patient.

## Key findings

- CRMO was diagnosed after recurrent musculoskeletal symptoms and imaging revealed multifocal bone marrow edema.
- The patient was successfully treated with analgesics alone, avoiding long-term antibiotic use.
- Early MRI detection of multifocal lesions is critical for diagnosing CRMO in similar cases.

## Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, non-infectious autoinflammatory bone disorder that predominantly affects children. Some studies have reported cases of CRMO in patients with autoimmune diseases such as inflammatory bowel disease (IBD). We encountered a rare pediatric case of CRMO in a patient with both IBD and primary sclerosing cholangitis (PSC). The patient was a 14-year-old male with a history of ulcerative colitis and PSC, both controlled with vedolizumab, who developed recurrent right wrist pain. Imaging revealed bone marrow edema suggestive of osteomyelitis. Initially suspected to be bacterial osteomyelitis, the patient was treated with antibiotics; however, symptoms recurred, and new lesions appeared on the heel, ultimately leading to a diagnosis of CRMO. The patient was successfully managed with analgesics alone, without antibiotics, and no long-term complications were observed. This is a rare pediatric case of CRMO occurring in the context of both IBD and PSC. Clinicians should consider CRMO in patients with IBD and PSC who present with musculoskeletal symptoms to avoid unnecessary antibiotic use. Early-stage diagnosis of CRMO can be achieved by detecting multifocal lesions on magnetic resonance imaging.