2011 Volume 4 Issue 1 Pages 37-40
Chronic nonbacterial osteitis/osteomyelitis（CNO）is a rare and possibly autoinflammatory disease characterized by chronic and recurrent bone pain often associated with low grade fever or general malaise． We report an eight-year-old girl with CNO presenting with recurrent spiking fever and bone pain． Her febrile episodes were associated with elevated erythrocyte sedimentation rate， serum C-reactive protein and IL- 181evels but not with serum levels of IFN-γ， IL-6，or TNF-α． Positron emission tomography demonstrated fluorodeoxyglucose accumulation in epiphyses of bilateral distal femurs and tarsal bones． Bone edema-1ike lesions with high intensity in short-tau inversion recovery image and low in Tl weighted image were documented in magnetic resonance imaging of lower extremities． Bacterial osteomyelitis and bone neoplasm were excluded by bone biopsy of distal femur． All of these findings were consistent with the diagnosis of CNO． Her fever and bone pain responded to a short course of corticosteroid therapy but not to non-steroidal anti-inflammatory drugs． We suggest that CNO should be considered as a diagnosis of high grade fever particularly associated with bone pain，and that innate immune mechanisms are involved in the pathogenesis．
