A 15-year-old male with a body mass index of 38 presented to Sirada Panupattanapong, MD, in Cleveland Clinic’s Center for Pediatric Rheumatology and Immunology, with a two month history of persistent chest pain. It had progressed to his neck and back and worsened with any body movement. Prior to his consult, a battery of cardiac and pulmonary tests had all proved negative. 

His chest wall exam was normal, but he mentioned a years-long history of severe, refractory body acne, consistent with nodulocystic acne and hidradenitis suppurativa. His bloodwork showed systemic inflammation, and magnetic resonance imaging of the chest wall and spine revealed multiple areas of contrast enhancement in the sternum, multiple costovertebral joints and multiple vertebrae, findings consistent with osteitis.

Watch the short case report below to reveal the diagnosis and treatment of a very rare inflammatory condition in children.