A rare case of monostotic Melorheostosis of right ulna presenting with chronic forearm pain - Case report

Introduction

Melorheostosis is extremely rare non-cancerous lesion of bone mainly affecting the long bones and soft tissues. The incidence is 0.9 per million population. It affects male and female equally and reported among children and early adulthood. Common symptoms include pain, deformity and restricted range of movement of affected joint.

Case presentation

A 28-year-old female presented with pain at right forearm for nine months. The pain was of insidious onset and progressive in nature with severity of VAS 7/10. On examination, no gross deformity of right forearm was noted, no tenderness along the bones and range of movement of right elbow and wrist joints were within normal limit. Radiograph of right forearm revealed sclerosis of entire right ulna with dripping candle wax appearance with bowing deformity of ulna. She underwent osteoplasty of right ulna and biopsy. Oral bisphosphonate was started.

Discussion

Due to the rarity of the condition, there is still no standard guideline of the treatment of Melorheostosis, the widely practiced mode of treatment is symptomatic with analgesics, contracture release and deformity correction in extreme cases. If the diagnosis is doubtful it is important to rule out other sinister causes such as infection and malignancy. Biopsy is indicated only to confirm diagnosis.

Conclusion

Early diagnosis of Melorheostosis still remains challenge due to paucity of the condition. Melorheostosis should be included in one of the differential diagnosis of any hypersclerotic conditions of bone.