case_images: PMC10853602_01
case_images: Family tree of the patient and imaging features. Family trees of the patient (a). Thoracolumbar kyphosis, with an irregular sequence; edges of vertebral bodies got sharp, and signals in vertebral bodies became uneven; wedge-shaped changes in different degrees of T12-L2 vertebral bodies, and long T1 and short T2 signals in T12 vertebral bodies (b). The bone density of both hands and wrists decreased; the left radiocarpal joint space disappeared; the metacarpophalangeal joint and interphalangeal joint space of both hands narrowed, and the joint surface hardened and rough; dislocation of the metacarpophalangeal joint of the right hand and proximal interphalangeal joint of the left middle finger (c).
case_images: cureus-0016-00000051986-i01.jpg
case_images: PMC10853602_01_cureus-0016-00000051986-i01.jpg
case_images: FIG1
case_images: Her parents are not close relatives, and many people in her family have a history of NF1 (Figure 1a) but no RA, systemic lupus erythematosus, or psoriasis. In 2019, she received bone cement surgery due to a fracture on the lumbar spine caused by osteoporosis (Figure 1b). X-rays of the wrists and hands were typical for RA (Figure 1c).
case_images: Clinical appearance of the skin lesions and joints. The patient was riddled with brown cafe-au-lait spots, patches, and soft nodules of different sizes (a). Ulnar deviation of the right hand; boutonniere deformity of one to five fingers (b).
case_images: cureus-0016-00000051986-i02.jpg
case_images: PMC10853602_01_cureus-0016-00000051986-i02.jpg
case_images: FIG2
case_images: They were soft and had no tenderness when touched (Figure 2a). Specialized physical examination showed that she had slight kyphosis on the spine, tenderness of the lumbar spine, multi-joint deformity on the hands and feet, ulnar deviation of the right hand, and boutonniere deformity of one to five fingers (Figure 2b).