Gkougkoulias AN, Vlychou M, Dailiana ZH. Monostotic chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis of clavicle mimicking malignant bone tumor: A case report and review of literature. World J Clin Cases 2026; 14(22): 122012 [DOI: 10.12998/wjcc.122012]
Corresponding Author of This Article
Zoe H Dailiana, Professor, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece. dailiana@med.uth.gr
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Orthopedics
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case-report
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Gkougkoulias AN, Vlychou M, Dailiana ZH. Monostotic chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis of clavicle mimicking malignant bone tumor: A case report and review of literature. World J Clin Cases 2026; 14(22): 122012 [DOI: 10.12998/wjcc.122012]
World J Clin Cases. Aug 6, 2026; 14(22): 122012 Published online Aug 6, 2026. doi: 10.12998/wjcc.122012
Monostotic chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis of clavicle mimicking malignant bone tumor: A case report and review of literature
Asterios N Gkougkoulias, Marianna Vlychou, Zoe H Dailiana
Asterios N Gkougkoulias, Marianna Vlychou, Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Thessalia, Greece
Zoe H Dailiana, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
Zoe H Dailiana, Department of Hand, Upper Extremity Surgery and Microsurgery, Iaso Thessalias, Larissa 41500, Greece
Author contributions: Dailiana ZH designed the report, determined the clinical significance of the case and treated the patient; Vlychou M performed the radiological analysis and image interpretation; Gkougkoulias AN contributed to radiological and data analysis and wrote the manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: AI contribution statement for the the manuscript entitled “Monostotic chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis of clavicle mimicking malignant bone tumor: A case report and review of literature”: AI tools were not used.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Zoe H Dailiana, Professor, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece. dailiana@med.uth.gr
Received: April 13, 2026 Revised: June 12, 2026 Accepted: June 26, 2026 Published online: August 6, 2026 Processing time: 114 Days and 22.7 Hours
Abstract
BACKGROUND
Bone tumors and tumor-like lesions are rare in children and adolescents and usually benign, while malignancies cannot be excluded. Rare entities such as chronic recurrent multifocal osteomyelitis (CRMO)/chronic nonbacterial osteomyelitis (CNO) should be also considered. CNO is a rare, non-infectious autoinflammatory bone disease that primarily affects children and adolescents. The clinically severe type is CRMO with multiple sites and waxing-waning course. The monostotic presentation of CNO as a solitary bone lesion may pose significant diagnostic challenges.
CASE SUMMARY
We present the case of a 13-year-old male athlete with a painful swelling of the left clavicle. Imaging studies revealed a morphologically aggressive lytic lesion indicative of primary malignant bone tumor. Histopathological analysis, however, excluded malignancy and supported a diagnosis of inflammatory osteomyelitis. Whole-body magnetic resonance imaging confirmed the monostotic nature of the lesion. Based on clinical, radiologic, and histological findings, a diagnosis of solitary CNO of the clavicle was established. The patient was treated conservatively with non-steroidal anti-inflammatory drugs and referred to a paediatric rheumatologist.
CONCLUSION
Including unusual entities as monostotic CRMO/CNO in the differential diagnosis of bone tumors avoids unnecessary surgical procedures or antibiotic use.
Core Tip: Monostotic chronic recurrent multifocal osteomyelitis/chronic nonbacterial osteomyelitis represents a diagnostic challenge, as its clinical and radiological features frequently overlap with those of aggressive osseous malignancies or infectious osteomyelitis. This case report underscores the necessity of a multifaceted diagnostic approach of bone tumors, integrating histopathological analysis and Whole-body magnetic resonance imaging to confirm a non-infectious inflammatory etiology. Recognizing this underestimated entity, is essential for clinicians to ensure accurate diagnosis, preclude unnecessary invasive surgical interventions, and implement effective conservative management strategies.
