A Unique Case of Melorheostosis Presenting with Two Radiologically Distinct Lesions in the Shoulder

Melorheostosis (Leri's Disease): A Review

Melorheostosis is a noncancerous bone disease characterized by abnormal bone and soft tissue growth. Despite being identified almost a century ago, there are still many unknown aspects surrounding this condition. It can often be an incidental discovery, with patients experiencing associated pain and deformities. Diagnosis typically relies on X-rays, although not all cases exhibit the classic candle wax appearance. A new imaging sign known as the "dumpling on a plate sign" has been proposed for flat bones for both MRI and CT scans. A biopsy may be necessary in cases of uncertainty, as there is not a definitive histological feature. It is not uncommon for melorheostosis to be linked with other conditions, and a collaborative approach involving a multidisciplinary team should be considered. This condition should be considered in the differential diagnosis of sclerotic bone conditions. Management is generally aimed at symptom relief, either through conservative measures or surgical intervention.

A Rare Case of Melorheostosis Presenting with Extra-osseous Lesions Around the Knee: Case Report

Introduction

Melorheostosis was initially identified in 1922 by Leri and Joanny. It is often referred to as candle bone disease, melting wax syndrome, or Leri disease. This mesenchymal condition is uncommon, benign, and non-heritable. There is still a lack of clarity regarding the underlying cause of the condition. The estimated incidence is 0.9% per million. No inherited traits have been identified, and both sexes are equally affected. Pain or swelling is the most typical symptoms, and the onset is insidious. People often call this condition "candle disease of the bone" because the radiological signs of it look like dripping candle wax.

Case Report

A 56-year-old female presented with an 8-year history of the left knee pain, swelling, and movement restriction. On examination, a hard, bony lump measuring 12×5 cm was located on the outer aspect of the left knee. The skin over the lump's surface was neither erythematous nor warm. Plain radiographs revealed a wide, dense, undulating, or irregular cortical hyperostosis, resembling candle wax, spreading along the length of the fibula bone as well as an extra-osseous calcification mass across the lateral aspect of the left knee. The patient underwent excision with complete left knee motion.

Conclusion

Melorheostosis' actual etiology is yet unknown. There is no established treatment for this condition. Only symptomatic treatment helps patients feel better; in some circumstances, the excision of a bone mass yields more beneficial results.

Cross-Sectional Imaging Useful in Melorheostosis

Melorheostosis is a rare disease of bone overgrowth that is primarily diagnosed based on imaging studies. Recently, the association of different radiological patterns of the disease with distinct genetic cause was reported. Several case reports have described the radiological findings in patients with melorheostosis. However, the added value of cross‐sectional imaging with CT and MRI beyond X‐rays has not been investigated. The aim of the current study was to investigate this existing gap in knowledge. Forty patients with melorheostosis seen at the National Institute of Health Clinical Center were included in the study, and all their imaging studies were analyzed. The sequence of interpretation was X‐ray followed by CT and then MRI. CT images were extracted from whole‐body 18F‐sodium fluoride positron emission tomography/CT studies. The information from CT reclassified the initial X‐rays based radiological pattern in 13 patients. Additionally, CT comprehensively identified joint involvement and disease extent. In 76% of patients (n = 29) who underwent MRI, additional findings were noted, ranging from soft tissue edema to identification of soft tissue masses and incidental findings. MRI did not provide additional information on skeletal lesions beyond CT scans. However, it revealed the extension of soft tissue ossification into ischiofemoral space in four patients who complained of deep gluteal pain consistent with ischiofemoral impingement syndrome. In addition, MRI revealed soft tissue edema in 20 patients, 9 of whom had bone marrow edema and periosteal edema in the tibias consistent with shin splints. These findings suggest that select patients with melorheostosis should be evaluated with both CT and MRI, particularly patients in whom the distribution of pain does not correlate with the anatomic location of the disease in plain radiographs. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

A Rare Case of Melorheostosis in the Hand of a Saudi Woman

Melorheostosis is a very rare bone dysplasia, especially in the hand. Most cases were diagnosed incidentally, with the lower limbs being the most affected. This is the first Saudi woman with hand melorheostosis. A 33-year-old Saudi female had mild to moderate right-hand pain that started six years ago. Hand examination showed a full range of motion and full hand grip, and there was no tenderness upon palpation. Plain X-ray, unenhanced CT scan, and MRI of the hand showed an appearance resembling dripping candle wax as melorheostosis. The bone scan showed a nonvascular and nonacute lesion. An unenhanced CT scan demonstrated cortical and endosteal hyperostosis involving the proximal, middle, and distal third and fourth phalanges. Multi-sequential MRI of the hand demonstrated cortical hyperostosis involving the ulnar and radial aspect of the right fourth proximal, middle, and distal phalanges. Features in the X-ray, CT scan, bone scan, and MRI confirmed a diagnosis of melorheostosis with associated flexor tenosynovitis.

A rare case of melorheostosis of the hand in a pediatric patient

Melorheostosis, a rare mesenchymal dysplasia of bone, generally affects about 0.001% of people globally with about 400 cases total being reported. Melorheostosis of the hand, especially in the pediatric population, has been seldom reported. Previous studies have investigated potential genetic mutations associated with melorheostosis however, questions still remain regarding effective treatment options for this disease. This case report describes a unique case of pediatric melorheostosis of the hand and further clarifies current theories on melorheostosis with regards to pathogenesis, best treatment practices, and future research.

Melorheostosis in an Adolescent with Limb Length Discrepancy and Management with Epiphysiodesis with Eight Plates

INTRODUCTION

Melorheostosis is a rare bone dysplasia. It is mainly a radiographic diagnosis with distinct findings of endosteal or periosteal sclerosis along the axis of long bones, resembling the flowing wax. It is usually polyostotic and monomelic. Clinical manifestations are pain, limitation of joint movements, deformities, and contractures. Leg length discrepancy may be found, usually the affected limb being shorter.

CASE PRESENTATION

We present an adolescent boy, with melorheostosis of the lower limb. The affected limb was longer with equally divided discrepancy of the femur and tibia. There were no another symptoms. After a thorough investigation, we performed epiphysiodesis both medial and lateral of the distal femoral and proximal tibial growth plate, using8eight plates. At the end of the growth, there was almost complete equalization of the length of his lower limbs.

CONCLUSION

Melorheostosis may be present with leg length discrepancy leg length discrepancy, with an exception, being that the affected limb is longer. Epiphysiodesis with eight plates is an effective method of limb length equalization.

Melorheostosis of The Leg: A Case Report

Melorheostosis is a benign hyperostotic disease of the peripheral skeleton, rarely involving the axial skeleton. This disease is associated with ossified and non-ossified soft tissue masses surrounding the joints. We report the case of a 28-year-old male who presented to an orthopedic clinic with a chronic history of right leg pain. Radiological evaluation using X-ray, computed tomography, and magnetic resonance imaging showed features consistent with that of melorheostosis. Recognition of this entity by clinicians can avoid unnecessary investigations and biopsy.

Debridement arthroplasty of a rare case of elbow stiffness. A case report and literature review

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Melorheostosis of the elbow associated with elbow stiffness is extremely rare.

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In the standard radiology or orthopedics literature Melorheostosis (from the Greek: melos = limb, rheos = flow) is described monotonously as a “flowing hyperostosis” resembling dripping candle wax.

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Patients with this condition may have joint pain, stiffness, deformity, and restricted range of motion due to bony and soft-tissue contracture. Involvement usually follows a sclerotomal distribution and usually affects only one extremity.

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There is no standard treatment for melorheostosis, and management plans must be made on an individual patient basis. The aims of treatment are pain relief and maintaining function.

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Some Surgical treatment for this condition includes tendon lengthening, excision of fibrous and osseous tissue, fasciotomy, capsulotomy, sympathectomy, corrective osteotomy, Ilizarov lengthening, arthrodesis, implant arthroplasty, and even amputation of severely affected limbs with vascular ischemia.

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In this study we found that debridement arthroplasty is safe and effective in treating elbow stiffness associated with Melorheostosis.

Introduction

Elbow stiffness is a common condition that affects the quality of life of patients. Melorheostosis of the elbow associated with elbow stiffness is extremely rare.

Presentation of case

We report the case of a 28 yr old male who presented with elbow stiffness which occurred within one year without prior history of trauma or infection. The patient had decrease in range of motion together with progressive worsening pain that forced him to seek medical attention.

Discussion

There is no standard treatment for melorheostosis, and management plans must be made on an individual patient basis. The aims of treatment are pain relief and maintaining function.

Conclusion

Debridement arthroplasty is safe and effective in treating elbow stiffness associated with Melorheostosis.