Melorheostosis of The Leg: A Case Report

Management of a case of melorheostosis deformity and pain with intramedullary nailing

Melorheostosis is a rare sclerosing bone dysplasia characterized by the thickening and irregular ossification of the affected bones. This disease can affect any bone in the skeletal system, with the long bones of the lower extremities being more frequently involved. Symptoms include pain, oedema, joint stiffness, muscle atrophy and bone deformity. Management of this disease is challenging and not standardized. It depends on the symptoms, and it varies from physical therapy to pharmacological approach or surgery to correct limb deformities, muscle and tendon contractures and joint stiffness. This case report presents the clinical management and treatment of a patient with lower limb deformities due to melorheostosis using retrograde intramedullary nailing of the femurs. The procedure provided stability to the affected bones, resulting in correction of deformities and alleviation of lower limb pain, improving her quality of life.

Dripping Wax Bone Disease - Melorheostosis - A Rare Case Scenario

Introduction

Melorheostosis is a rare condition affecting the bones and has only been occasionally reported. We herein report a case of melorheostosis affecting left femur and tibia which was diagnosed based on clinical and radiological features and managed with bisphosphonates.

Case Report

A 28-year-old female patient presented with complaints of pain over left knee and thigh for the past 3 months. To evaluate the cause of pain X-ray and magnetic resonance imaging were done, which revealed characteristic candle dripping wax appearance suggestive of melorheostosis. After arriving at the diagnosis patient was started on nonsteroidal anti-inflammatory drugs and pamidronate which provided symptomatic betterment patient has now been followed up for past 1 year and is symptom free.

Conclusion

Melorheostosis is an uncommon cause of a common symptom. Positive clinical and imaging features helped us to arrive at the diagnosis. Proper work up would help in early diagnosis and management. More evidence is needed to illustrate the effectiveness of medical or surgical treatments for patients with this rare diagnosis.

The dripping candle wax sign of melorheostosis

Melorheostosis is a rare benign bone disease including dysostosis and sclerosis. Dripping candle wax presence is a common and typical sign of melorheostosis. This sign appears as irregular hyperostosis of the cortical bone which is likened to melted wax flowing down one side of a candle. It can sometimes cause pain, stiffness joint, or limitation of motion in the affected areas implicitly but mostly has no symptoms. It is usually observed on plain radiography; its appearance is generally hyperplasia on one side of the bone. We report a 33-year-old male who has an incidental diagnosis of melorheostosis post-trauma.