Spotted bone disease

Excerpt

A 34-year-old Caucasian male presented to the outpatient clinic with a 2-year history of knee and tibia pain, which was worse during bedtime resting. He reported no acute injury; however, he used to play volleyball in a non-professional team for many years. There was no morning stiffness, fever, or weight loss. Physical examination was unremarkable; the patient looked healthy with no dysmorphic features. He had no family history of musculoskeletal disease. X-ray revealed multiple, well-defined, circular, and ovoid sclerotic lesions in the femur, tibia and fibula of both legs (Fig. 1). Lesions were symmetrical, clustered around the joints, involving the epiphyses and metaphyses with a predominantly longitudinal alignment. Patient’s serum calcium, phosphates, and alkaline phosphatase levels were within normal limits. The patient denied further imaging studies (bone scan/multiple X-rays). Review of a previous x-ray of his right shoulder taken 4 years ago for traumatic injury demonstrated similar lesions in the humerus. The bone lesions are typical of osteopoikilosis, or spotted bone disease. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) were suggested for pain control.

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