A Case of Sterile Osteomyelitis: Chronic Recurrent Multifocal Osteomyelitis (CRMO).

Chronic recurrent multifocal osteomyelitis (CRMO) is a rarely reported autoimmune inflammatory condition affecting children and young adults. The typical complaint is recurrent severe bone pain at multiple sites; often imaging suggests features of osteomyelitis or malignancy. However, the biopsy is always negative for any growth in culture and histopathology detects only inflammatory cells. This is a diagnosis of exclusion with various diagnostic criteria. We had a 20-year-old male presenting with recurring pain and swelling in the right hand and left foot for more than seven months. Imaging revealed bone marrow edema with the expansion of bone and sclerosis involving the third metacarpal of the right hand and first metatarsal of the left foot. Acute phase reactants were mildly raised with biopsy showing inflammatory cells. However, the cultures grown from the lesion were sterile. After comparing it with the various diagnostic criteria, a diagnosis of CRMO was made.

Unusual Locations of Pancreatic Pseudocysts in Lumbar Triangle, Psoas Muscle and Intercostal Space, and Obturator Externus.

Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of pseudocyst can occur into mesentery, retroperitoneum, inguinal region, scrotum, liver, spleen, mediastinum, pleura, and lung. Extension of pseudocyst into psoas muscle and lumbar triangle is extremely rare. The development of pseudocyst in lumbar triangle is radiologically equivalent and further extension of Grey Turner's sign seen clinically in acute pancreatitis. This extension occurs due to the destructive nature of pancreatic enzymes. The lumbar triangle is the site of anatomic weakness in the lateral abdominal wall in the lumbar region. We report the case of a 35-year-old alcoholic male patient who presented with abdominal pain followed by distension and swelling in the right lumbar region for 1 week. On computed tomography scan of the abdomen, acute-on-chronic pancreatitis with multiple pseudocysts in the right posterior pararenal space, extending through the right lumbar triangle in the right lateral abdominal wall, right posterior paraspinal muscles, right iliopsoas, right obturator externus, and medial aspect of the right upper thigh, beneath anterior abdominal wall in the upper abdomen and in the right lateral thoracic wall through the right 11th intercostal space, was detected.