Bhavin commented:
The classic definition of CNO is the 9-14 years age-range.
But since CRMO, SAPHO are all in the end non-bacterial osteitis, it just makes sense to bring them all under the umbrella term and then assume that within CNO there are subtypes or different phenotypes.
I guess one other issue that will likely decide how they will get grouped is response to IV pamidronate. All these generally show amazing response.
My colleague spoke to the secretary in the referrer’s office who read her relevant information from the chart.
The biopsy from Jan 2024 was reported as acute osteomyelitis.
Cultures were all negative except one showing P. acnes.
The clinical notes subsequent to that all say SAPHO syndrome, and that seems to be the presumed dx.
I know nothing about any subsequent treatment. Clearly he has tremendous enhancing retrosternal inflammation and ongoing symptoms.
Thanks to everyone who commented.
Hilary
On Tue, Apr 2, 2024 at 2:48 PM hilary wrote:
This MRI is from today, apparently he had a biopsy in January and this MRI is to correlate with those results that they have not shared with us
His baseline imaging exam with us was in November 2022
Reported as suspicious for sarcoma, although there was mention that the changes extend to the sternum….not demonstrated in these images
There is involvement of the Left > Right clavicle and bilateral anteromedial 1st and 2nd ribs
Bone Scan and CT all reported as suspected malignancy and recommended biopsy
I think the images are diagnostic of SAPHO syndrome
I can’t think of a reasonable differential diagnosis, can you?
I suppose we can hunt down the biopsy result, but I suspect it is what it is
*this case is courtesy of my colleague Dr Liebeskind
