Infantile peri-osteitis

Abstract

A 14-week-old girl was brought in with a history of painful swelling of both legs since the age of one month. The onset was insidious and was not associated with trauma or fall. There was no history of fever or associated constitutional symptoms. The birth history was normal and the infant was apparently asymptomatic until the age of one month. Examination revealed a healthy and alert infant. Both legs were bowed anteriorly and a uniform bony thickening of both tibiae was palpable throughout their lengths (figure 1). Both legs were extremely tender and the infant would withdraw both lower limbs and cry incessantly if any attempt was made to touch them. There was no increase in local temperature nor redness of the overlying skin. Knees and ankle joints were normal and demonstrated a full range of motion. Regional lymph nodes were not enlarged and other bones and joints were normal on examination. X-Rays of both legs revealed peri-osteitis of both tibiae with extensive subperiosteal new bone formation involving the entire diaphysis (figure 2).Questions

COL1A1 Mutation in an Indian Child with Caffey Disease

“…It is an important differential diagnosis to be considered in a case of infantile peri-osteitis, the others being post-traumatic inflammation/battered baby syndrome, osteomyelitis, congenital syphilis, scurvy, hyperphosphatemia, hypervitaminosis A and tumors such as Ewing sarcoma and metastatic neuroblastoma [6]. It is a heterogeneous disorder and both sporadic and familial cases are known to occur.…”

Scintigraphic and radiological correlative and confirmative features obviating invasive biopsy in caffey′s disease

“…The disease has been described in many bones, including the mandible, tibia, ulna, clavicle, scapula, ribs, humerus, femur, fibula, skull, scapula, ilium, and metatarsals. [ 4 ] Differential diagnosis includes osteomyelitis, battered baby syndrome, and congenital syphilis. It may recur and rarely cause deformities.…”

Successful Treatment of Chronic Recurrent Multifocal Osteomyelitis With Indomethacin

“…Nevertheless, in more advanced stages, there is an inflammatory infiltrate of lymphoplasmacyte, histiocytes, osteoblasts, and formation of new bone. 10 Different treatments have been used on cases of CRMO; however, none has managed to control the disease. This periostitis is similar to that found in cases of intestinal inflammatory diseases 3,4,11 or in Caffey disease.…”

“…The hypothesis of an infection describes germs that grow slowly or that require special cultivation media. 3,4,10,11 Radiologically, this translates into images of osteolysis and zones of sclerosis associated with bone growth because of periosteal apposition around the inflamed zone. 1,6Y9 The affected bone undergoes tissue inflammation with periostitis, leading to the appearance of a form of subperiosteal bone apposition that is similar to the phenomena described in other processes such as Caffey disease and hypervitaminosis A, 10 or to those described in intestinal inflammatory diseases.…”