From bone pain to abdominal pain: When chronic recurrent multifocal osteomyelitis is associated with ulcerative colitis

We report the case of a 10-year-old white girl who presented with a 6-month history of diffuse bone pain and difficulty in walking. Whole-body magnetic resonance imaging (MRI) showed several areas of signal abnormality, suggesting the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). After 1 year, abdominal pain and mucus in stools occasionally occurred in the absence of diarrhea and ematochezi. Despite being rare, fluctuating fecal calprotectin value and abdominal symptoms led us to consider the association of CRMO with inflammatory bowel disease (IBD). The final diagnosis was UC associated with CRMO. Thus, the treatment with tumor necrotic factoralpha (TNF-a) inhibitors was started. After 1 month of the therapy, the inflammatory marker had been completely negativized, and at 6 months from the beginning of the therapy, the complete regression of each bone lesion was observed in total body MRI.