An Unusual Association of Chronic Recurrent Multifocal Osteomyelitis, Pyoderma Gangrenosum, and Takayasu Arteritis

To the Editor: Chronic recurrent multifocal osteomyelitis (CRMO) is hypothesized to be an autoimmune disorder because of its association with multiple autoimmune diseases, including inflammatory bowel disease, psoriasis, acne, pustulosis, Sweet syndrome, dyserythropoietic anemia, pyoderma gangrenosum (PG), sclerosing cholangitis, inflammatory arthritis, Still disease, Takayasu arteritis (TA), Ollier disease, and dermatomyositis1,2. PG association with TA is rare; however, Ujiie, et al showed that PG is associated with TA in 33% of patients3. Occurrence of all 3 conditions together (CRMO, PG, and TA) is very rarely reported. A 10-year-old girl born to nonconsanguineous parents presented with a history of intermittent swelling over the right side of the mandible, associated with pain and claudication pain over legs and back with breathlessness on exertion for the past 2 years. She also developed ulcerative cauliflower-like skin lesions over the dorsum of left foot over the past 2 months (Figure 1). On examination, her pulses were absent … Address correspondence to Dr. S. Kumar, Christian Medical College, Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu 632004, India. E-mail: sathishkumar{at}cmcvellore.ac.in

致编辑： 慢性复发性多灶性骨髓炎（CRMO）被假定为一种自身免疫性疾病，因为它与多种自身免疫性疾病相关，包括炎症性肠病、银屑病、痤疮、脓疱病、Sweet综合征、红细胞生成异常性贫血、坏疽性脓皮病（PG）、硬化性胆管炎、炎症性关节炎、Still病、高安动脉炎（TA）、奥利埃病和皮肌炎1,2。 坏疽性脓皮病与高安动脉炎的关联很罕见；然而，Ujiie等人表明，33%的患者中坏疽性脓皮病与高安动脉炎相关3。 这三种疾病（CRMO、PG和TA）同时发生的情况极少有报道。 一名父母非近亲结婚的10岁女孩，有下颌骨右侧间歇性肿胀病史，伴有疼痛，过去2年腿部和背部跛行疼痛，运动时呼吸困难。过去2个月，她左脚背还出现了溃疡性菜花状皮肤病变（图1）。检查时，她的脉搏消失…… 通信地址：印度泰米尔纳德邦韦洛尔市基督教医学院儿科系S.库马尔博士，邮编632004。电子邮箱：sathishkumar{at}cmcvellore.ac.in