Male patient in 2009 for control of Bone Metabolic Unit (BMU) with 36 years and diagnosed in a private center of monostotic Paget disease of the left radius.
The patient reported biopsy and scintigraphy in 2007.
She was treated with risedronate at the dose used for osteoporosis.
Riseddronate was discontinued in 2009 due to the good result in P1NP levels (amino-terminal propeptide type 1).
Since then and until November 2014, it was periodically monitored with serum levels of bone markers indicating a new low-dose risedronate cycle for a few months, when they increased.
Also in this time interval a gammagraphy was performed without finding significant changes compared to the previous one.
When the treatment was administered, the patient improved his local pain clinic, but in November 2014 he went spontaneously to the consultation with the arm in a sling indicating that two days ago he suffered a casual fall and experienced intense pain in the left area.
Physical examination revealed a hematoma on the dorsum of the hand and distal third of the forearm, edema, blurred tendon grooves on the back of the hand, functional impotence and increased local wrist temperature.
a The patient was suspected of having a fracture since the Metabolic Unit was referred to the emergency department where X-rays were performed; he was discharged with the diagnosis of contusion because there was no evidence of any fracture, but a new lesion
Although the X-rays did not show evidence of malignancy, an urgent computed tomography (CAT) and nuclear magnetic resonance (NMR) were requested for the study of fracture in hyperosteum.
The CT scan showed a fracture in the hamate bone and sickle cell disease.
The limb was immobilized with a posterior splint.
Once the trauma emergency was resolved, the radiological lesion of the radius was re-evaluated in subsequent days, identifying the so-called “slip-off ulcer” sign.
The possibility of presenting meloretosis was commented on this option to the services of Radiology and Nuclear Medicine to submit it to its consideration.
Finally, it was accepted as an alternative diagnosis to Paget's disease of bone, being indistinguishable scintigraphically.
Once confirmed and agreed upon the new diagnosis of meloreostosis, we resumed the anamnesis, which highlights the report of a fall at 14 years while practicing sports.
The patient reported having suffered severe pain in the radius, but did not go to any health center and was referred to her parents with a deformity since then.
The pain subsided weeks after that fall.
We deduced that the patient fractured the radius and, as the fracture was not immobilized or reduced, he remained with this deformity, which can be seen in Figure 1, but which is not directly related to hyperostosis.
In addition to the striking central image, there are other areas of hyperostosis inside the distal extremity of the radius and in the proximal third.
