Clinical Picture
Osteopoikilosis Amara Ogbonnaya, Brittany Middleton, Tiffany Cady, Cynthia Ho
A 17-year-old boy came to our hospital with a wound infection 5 days after urological surgery. CT scan done to assess the depth of the infection showed multiple well circumscribed, ovoid, radiodense bony lesions in the pelvis and proximal femurs, consistent with the diagnosis of osteopoikilosis. Osteopoikilosis or “spotted bone disease” is a rare, benign, autosomal dominant disorder characterised by sclerotic bone lesions most commonly involving the hands, feet, pelvis, and ends of long bones.1,2 Lesions are typically found incidentally on imaging studies done for unrelated complaints.3 The symmetric distribution, lack of bone destruction, and location differentiates osteopoikilosis from metastatic disease, which tends to be seen more often in ribs, vertebral bodies, and the diaphysis of long bones.4 Bone
scintigraphy is normal in patients with osteopoikilosis.2,4 Early recognition is essential to prevent unnecessary emotional distress and invasive testing.3 No routine follow-up or studies are necessary. References 1 Woyciechowsky TG, Monticielo, MR, Keiserman B, Monticielo OA. Osteopoikilosis: what does the rheumatologist must know about it? Clin Rheumatol 2012; 31: 745–48. 2 Paraskevas G, Raikos A, Stavrakas M, Spanidou S, Papaziogas B. Osteopoikilosis: a case report of a symptomatic patient. J Radiol Case Rep 2009; 3: 38–43. 3 Carpintero P, Abad JA, Serrano P, Serrano JA, Rodríguez P, Castro L. Clinical features of ten cases of osteopoikilosis. Clin Rheumatol 2004; 23: 505–08. 4 Tuncel M, Caner B. Osteopoikilosis: a major diagnostic problem solved by bone scintigraphy. Rev Esp Med Nucl Imagen Mol 2012; 21: 93–96.
Published Online August 2, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)60674-1 Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA (A Ogbonnaya MD, B Middleton MD, T Cady DO, C Ho MD) Correspondence to: Dr Cynthia Ho, Los Angeles County and University of Southern California Medical Center, 2020 Zonal Avenue, IRD Room 109, Los Angeles, CA 90033
[email protected]
Figure: CT scan of pelvis in a patient with osteopoikilosis
www.thelancet.com Published online August 2, 2013 http://dx.doi.org/10.1016/S0140-6736(13)60674-1
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