[Bilateral periostitis and arthritis: about a case of hypertrophic osteoarthropathy]. / Périostite bilatérale et polyarthrite : à propos d'un cas d'ostéoarthropathie hypertrophique pneumique.

We report the case of a 67-year-old female patient presenting swelling of the hands and feet and pain in both legs. Clinical examination and bone scintigraphy identify the triad "digital clubbing - arthritis - bilateral periostitis of the long bones", leading to a diagnosis of hypertrophic osteoarthropathy, a syndrome usually associated with pulmonary neoplasia. The thoracic CT-scan, followed by a biopsy, effectively diagnosed a right upper lobe adenocarcinoma. Surgical treatment of the neoplasia allowed the resolution of the clinical complaints and the pathological scintigraphic findings.

Nous rapportons le cas d'une patiente de 67 ans présentant des gonflements des mains et des pieds ainsi que des douleurs des deux jambes. L'examen clinique et la scintigraphie osseuse identifient la triade «hippocratisme digital - arthrites - périostite bilatérale des os longs¼, permettant de poser un diagnostic d'ostéoarthropathie hypertrophique, un syndrome habituellement associé à une néoplasie pulmonaire. Le scanner thoracique, suivi d'une biopsie, ont en effet diagnostiqué un adénocarcinome localisé au niveau du lobe supérieur droit. La prise en charge chirurgicale de la néoplasie a permis la résolution des plaintes cliniques et de l'aspect scintigraphique pathologique.

Bioarchaeology of adaptation to a marginal environment in bronze age Western China.

OBJECTIVES: This study examines human adaptation to the 4000 BP climate change event, which is said to have increased the marginality of Inner Asian environments. We propose to define "marginal" environments not in relation to a specific economic activity (e.g., agriculture), but in relation to whether humans living there are physiologically stressed. METHODS: Three sites in the Hexi Corridor of Gansu were studied, one from the early and two from the late Bronze Age (N = 125). The study includes three indicators of physiological stress: linear enamel hypoplasias (LEH); tibial periosteal lesions; and fertility. The early and late Bronze Age groups were compared to examine whether human physiological stress increased. RESULTS: The percent of individuals with LEH declined dramatically, indicating fewer growth disruptions. Tibial periosteal reactions also changed, from mostly active to mostly healing at the time of death, indicating that frailty declined. Fertility, which is sensitive to changes in population health and resource availability, did not change significantly. CONCLUSIONS: Counter to the dominant narrative of environmental deterioration and subsistence system collapse, the Bronze Age residents of the Hexi Corridor show no skeletal evidence that they suffered from resource shortages or struggled to adapt in the fluctuating climate that pertained after the 4000 BP climate event. In fact, this study found that people suffered from less frailty and fewer growth disruptions after the unstable climate had persisted for some time. Therefore, in human biological terms, the Hexi Corridor did not become more marginal for human habitation during the Bronze Age.

Periostitis Ossificans Arising in the Mandibular Bone of a Young Patient: Report of an Unusual Case and Review of the Literature.

Periostitis ossificans, also known as Garré osteomyelitis, is a specific type of chronic osteomyelitis that forms new bone under the periosteum resulting from a periosteal reaction to chronic inflammation or infections. It commonly affects the mandible secondary to odontogenic infection. The therapeutic approach involves eliminating the infectious cause and antibiotic administration. This report describes an unusual case of periostitis ossificans arising from the mandible of an 11-year-old boy. The cause of infection was correlated with a lower right unerupted third molar, which had no obvious connection with the oral cavity. The histologic diagnosis was chronic osteomyelitis with proliferative periostitis. The patient has been followed for 1 year, without any evidence of recurrence. Periostitis ossificans can be diagnostically problematic, and various conditions must be considered in the differential diagnosis.

Florid reactive periostitis of the long bone: A case series of seven patients.

BACKGROUND: Florid reactive periostitis (FRP) is a rare benign periosteal lesion, which mostly involves the tubular bones of the extremities. FRP of the long bone is especially rare. We here report a case series of long bone FRP and also discuss the differential diagnosis and clinical outcome of our series. PATIENTS AND METHODS: In total, four female and three male patients with long bone FRP and a mean age of 25.1 years were evaluated for this study, from which four upper extremity and three lower extremity FRP lesions were identified. Patients were classified according to the clinical, radiological and pathological manifestations of the lesion. RESULTS: Periosteal reaction and edema around the lesions were observed in all cases. Calcified mass, bone marrow edema and cortical erosion were observed in six out of seven patients. Moreover, two lesions with peripheral mineralization and zoning appearances were observed. Limb rest and anti-inflammatory therapy proved to be sufficient treatment in all cases. The lesions were spontaneously resolved in all cases, leaving a residual exostosis. CONCLUSION: Our report indicates that short bone and long bone FRP could reveal different characteristics in some aspects, including the choice of the therapeutic approach. In spite of the favorable clinical outcome of long bone FRP, its differentiation from more aggressive lesions, especially osteosarcoma and osteomyelitis, should still be taken into consideration. In addition, according to our evidence, the implication of the zonal pattern in differential diagnosis of FRP and myositis ossificans (MO) could be re-evaluated.

Pachydermoperiostosis.

A case of Pachydermoperiostosis (PDP) presented to us in rheumatology clinic with complaints of enlargement and broadening of bilateral hands and feet, grade IV digital clubbing, coarsening of facial features, excessive sweating of the palms, soles during summers.

Sclerotic multiple myeloma with an unusual sunburst periosteal reaction occurring in the sternum.

Multiple myeloma is a disseminated neoplastic monoclonal gammopathy that usually affects the skull, clavicle, rib, pelvis, spinal column, and proximal portions of the humerus and femur. The initial manifestation of multiple myeloma in the sternum is rare. The classic radiological presentations of multiple myeloma are multiple "punched-out" areas of bone destruction, expansile lytic lesions, and generalized osteoporosis. Primary sclerotic presentation is rare and occurs in only 3 % of cases. A sclerotic multiple myeloma with a sunburst periosteal reaction occurring in the sternum has not been reported in the English literature. We report a case of sclerotic multiple myeloma of a 49-year-old woman. In the sternum, the lesion displayed extensive sclerosis mixed with mottled lytic areas with a sunburst periosteal reaction occurring in the periphery, which radiologically mimicked an osteosarcoma. Multiple focal areas of sclerosis were also found in the right clavicle, pelvis, multiple ribs, and vertebrae.

Deficiency of interleukin-1 receptor antagonist responsive to anakinra.

We describe a 3-month-old infant who presented to our institution with interleukin (IL)-1 receptor antagonist deficiency (DIRA), which consists of neutrophilic pustular dermatosis, periostitis, aseptic multifocal osteomyelitis, and persistently high acute-phase reactants. Skin findings promptly improved upon initiation of treatment with anakinra (recombinant human IL-1 receptor antagonist), and the bony lesions and systemic inflammation resolved with continued therapy.

Complete form of pachydermoperiostosis: a case report.

Pachydermoperiostosis is a primary form of hypertrophic osteoarthropathy, which presents with pachydermia, digital clubbing, and radiologic periostosis. Pachydermoperiostosis occurs owing to mutations of the gene encoding for 15-hydroxyprostaglandin dehydrogenase (15HPGD). Clinical manifestations of PDP are thought to relate to excessive collagen formation and dysregulation of matrix proteins because of fibroblastic hyperactivation. We present a very rare case of the complete form of pachydermoperiostosis in a young Indian male.

MRI features of cortical desmoid in acute knee trauma.

OBJECTIVE: The purpose of this study was to describe the MRI features of cortical desmoids associated with acute trauma. CONCLUSION: Marrow edema, periostitis, and adjacent soft-tissue edema can be seen in cases of cortical desmoid associated with acute trauma.

Medication-induced periostitis in lung transplant patients: periostitis deformans revisited.

We report five cases of diffuse periostitis resembling hypertrophic osteoarthropathy and perostitis deformans in lung transplantation patients on chronic voriconazole, a fluoride-containing compound. Although drug-related periostitis has long been known, the association of lung transplant medication with periostitis was only recently introduced in the literature. To our knowledge, imaging findings have not been fully characterized in the radiology literature. Imaging features along with clinical history help to distinguish this benign condition from other disease entities. In this article, we review the current literature and illustrate the variety of imaging characteristics of this entity so that interpreting radiologists can make accurate diagnoses and avoid unnecessary work up.

Periostitis of the metatarsal caused by a date palm thorn in a child: a case report.

Date palm thorn injuries are common in Middle Eastern countries, where there are many date palm plantations. If detected, these injuries can be treated without subsequent complications. In children, however, the diagnosis can very easily be missed. An untreated embedded thorn may cause late complications, including periostitis or osteomyelitis. In this article, the author presents a case of date palm thorn-induced periostitis of the fourth metatarsal. The lesion was successfully treated in this 10-year-old male by curettage of the lesion and removal of the thorn embedded in the periosteum of the metatarsal. The presence of the date palm thorn was confirmed with ultrasound scan and computerized tomography.

[Observation of dirofilariosis in the practical work of the otorhinolaryngologist].

A case of dirofilariosis is reported. The disease is believed to be caused by the contact with the cat that the patient brought in from Uzbekistan. The authors emphasize the importance of analysis of the medical history of the patients presenting with the pathology being considered, their medical examination, and correct interpretation of X-ray images of the paranasal sinuses taking into account the possibility of distribution of rare helminth species beyond their usual ranges.

Isolated periostitis as a manifestation of systemic vasculitis in a child: imaging features.

We report a case of isolated periostitis associated with Takayasu arteritis in a 10-year-old boy presenting with calf pain. Radiographs revealed a localized, thick periosteal reaction with irregular margin in the proximal left fibula. MRI revealed irregular thickening with enhancement of the periosteum in the proximal fibula and heterogeneous enhancement along vascular bundles in the calf. Isolated periostitis is a rare skeletal manifestation of systemic vasculitis that could be misdiagnosed as neoplastic or traumatic periosteal reaction.

[Peculiarities of face regional hemodynamics in treatment of acute purulent jaw odontogenic periostitis].

53 patients were under observation with acute purulent jaw odontogenic periostitis. In 27 out of them after operation as drainage material strips of napkin were used, containing as the active components metronidazol, dimexide and sodium alginate. Curative process efficacy evaluation was done according to the data of hemodynamic study (determination of the artery's diameter, maximal systolic speed and index of circulatory resistance) of the magistral face arteries. It was established that in the group of patients with rational treatment blood circulation in face arterial vessels was restored most actively than in the control group with the use of traditional treatment scheme.