Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder predominantly affecting pediatric and adolescent populations. The clinical presentation is heterogeneous, with persistent pain and swelling representing the most frequent and often initial symptoms. These manifestations are commonly localized to the mandible, although involvement of other skeletal sites, including long bones, clavicle, and vertebrae, may occur in more advanced cases. Beyond localized symptoms, some patients exhibit mild systemic features such as low-grade fever, fatigue, or malaise; however, these systemic signs are generally less pronounced than those observed in infectious osteomyelitis. The diagnostic evaluation of CNO is intricate and necessitates a systematic, multi-modal approach. Clinicians must integrate clinical assessment with imaging and laboratory investigations. Radiological modalities, particularly computed tomography (CT), are instrumental in delineating the extent and distribution of osseous lesions. In select cases, bone biopsy is indispensable to exclude differential diagnoses such as primary bone malignancies or metastatic disease. Histopathological examination and microbiological cultures derived from biopsy specimens are critical for confirming the absence of infectious pathogens, thereby facilitating the differentiation of CNO from bacterial osteomyelitis.
Dagher et al. (Sun,) studied this question.