When fever comes first: an unusual presentation of chronic non-bacterial osteomyelitis

Document Type

Journal Article

Publication Date

12-15-2025

Journal

BMJ case reports

Volume

18

Issue

12

DOI

10.1136/bcr-2025-269450

Keywords

Chronic recurrent multifocal osteomyelitis; Fever of Unknown Origin; Pediatrics; Rheumatology

Abstract

Chronic non-bacterial osteomyelitis (CNO) is a rare, autoinflammatory bone disorder that primarily affects children and adolescents. Bone pain is its hallmark, though other symptoms may occur. The gradual onset and variable presentation make CNO difficult to diagnose and can delay treatment. Notably, systemic signs such as fever or weight loss are recognised but less common manifestations of the disease and are rarely the initial complaint.We report an adolescent male with two weeks of daily fevers, rigours, night sweats, headaches and weight loss. Bone pain appeared later, intermittently affecting multiple joints. Ultimately, MRI and bone biopsy results supported an autoinflammatory process. Symptoms and inflammatory markers improved with non-steroidal anti-inflammatory drugs, supporting the diagnosis of CNO.This case emphasises the atypical presentation and highlights the need to consider CNO in children with prolonged fever of unclear origin, even when bone pain is not the presenting symptom.

Department

Pediatrics

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