Chronic non-bacterial osteomyelitis of distal ulna in a paediatric patient: a case report and review of literature

Abstract

Chronic non-bacterial osteomyelitis (CNO) is a rare disorder characterized by focal aseptic inflammation with a self-limiting, relapsing course of disease with female predominance and usually observed in paediatric age groups diagnosed by clinical, radiological and histopathological findings after ruling out all other differentials. We reported this rare case found in a 7 year old female with a history of greenstick fracture of distal ulna 3 years ago with flaring up of pain and swelling since trivial trauma to left wrist 1 month ago. We emphasize on the relevant data and findings to reach the conclusive diagnosis and treatment of the disease. CNO can present as benign unifocal non-relapsing to more severe form of multifocal relapsing inflammatory lesions involving metaphysis of long bones, vertebrae, clavicle and mandible. Diagnosis is made after excluding infection, malignancy, auto-immune and metabolic disorders. Treatment is mainly empirical to reduce pain and inflammation through NSAIDs, corticosteroids, bisphosphonates and sometimes TNF alpha inhibitors as no proper guidelines are available.