Zoledronate-Associated Seizure in Chronic Recurrent Multifocal Osteomyelitis

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease characterisedby sterile bone lesions. We report a case of a seven-year-old female patient who presented at a university hospitalin 2010 and 2018 with CRMO. While the most promising results have been observed in patients under treatment with bisphosphonates (BPs), the initial decision to treat the current patient with a dose of zoledronic acid every six months was recalled as the patient developed tonic-clonic seizures immediately following the second dose BP administration. Following recall, the patient maintained a prompt response at follow-up and her disease remained controlled with non-steroidal anti-inflammatory drugs. The current case report speculates a possible relationship between BP use and a possible seizure threshold reduction, thereby emphasising the need for closer monitoring when BPs are used.
Keywords: Chronic Recurrent Multifocal Osteomyelitis; Bisphosphonate; Tonic-clonic seizure; Case Report; Tunisia.