A 35-year-old female patient undergoing outpatient monitoring at the Specialist Medical Outpatient Clinic (AME, in portuguese acronym) in Mogi Guaçu, São Paulo, Brazil.Since childhood the patient has presented generalized pain in the body, mainly in the lower limbs, which has been more intense for the last 2 years, with no relation to physical effort, and which gets worse with changes in ambient temperature. Generalized weakness, reduced muscle strength and discreetly staggering gait have also been reported, as well the use of hearing aids. Faced with these symptoms, the patient sought successive health services, where she only received symptomatic treatment. Due to the persistence of the complaint, she underwent an X-ray of the lower limbs.Based on the radiographic changes found, bone scintigraphy and magnetic resonance imaging (MRI) examinations were requested. There are no known cases in the family.
resultsThe MRI revealed exuberant diffuse cortical thickening in the bone diaphyses, increased diameter of both femurs, intramedullary and peripheral femoral hyperintensity focal areas in the T2 weighted sequences, with enhancement after infusion of the intravenous contrast medium, which may correspond to areas of edema or inflammatory activity. The contracting mass of the muscle and subcutaneous plane had a preserved signal (Figure 1).