case_images: PMC11798652_01
case_images: Anteroposterior X-ray distal right femur. Seen is a heterogeneous lytic and sclerotic region in the distal diaphysis (oblique arrow).
case_images: cureus-0017-00000077028-i01.jpg
case_images: PMC11798652_01_cureus-0017-00000077028-i01.jpg
case_images: FIG1
case_images: The X-ray again showed increasingly extensive lytic lesions in the proximal tibia and femur that appeared non-aggressive (Figure 1). 
case_images: The 1.5T MRI coronal fat-saturated T2-weighted image of the bilateral femora. Extensive marrow edema is noted in the left femoral metadiaphysis with subperiosteal fluid and paraosseous myositis (short horizontal arrow). Residual finding of marrow edema is observed in the right femoral metaphysis, with a lateral biopsy tract (long oblique arrow) and no significant extraosseous findings.
case_images: cureus-0017-00000077028-i02.jpg
case_images: PMC11798652_01_cureus-0017-00000077028-i02.jpg
case_images: FIG2
case_images: Repeat MRI of the femur showed extensive changes consistent with osteomyelitis of the distal femur bilaterally with a large posterior sub-periosteal abscess and a smaller lateral sub-periosteal abscess at the posterior aspect of the distal right femur with probable pus in the distal diaphysis and metaphysis of the left and right femur (Figure 2).
case_images: The 1.5T MRI sagittal T2 Dixon water image of the right humerus. Extensive marrow edema is observed in the metadiaphysis (two long horizontal arrows) with subperiosteal fluid at the metaphysis (short horizontal arrow), and paraosseous myositis (short oblique arrow).
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case_images: PMC11798652_01_cureus-0017-00000077028-i03.jpg
case_images: FIG3
case_images: An MRI of the upper extremity showed extensive intramedullary edema at the proximal humerus extending into the distal humeral metaphysis with periostitis (Figure 3). 
case_images: Bone biopsy showing numerous large aggregates of large histiocytic cells with copious eosinophilic cytoplasm characteristic of Gaucher disease (arrow)
case_images: cureus-0017-00000077028-i04.jpg
case_images: PMC11798652_01_cureus-0017-00000077028-i04.jpg
case_images: FIG4
case_images: The bone biopsy of the right distal femur showed morphologic findings characteristic of GD: numerous large aggregates of large histiocytic cells with copious eosinophilic cytoplasm (Figure 4).