Presentation
Work up for bilateral wrist pain. A long history of proteinuria under treatment of corticosteroids and also pamidronate therapy because of secondary osteomalacia.
Patient Data
Multiple prominent horizontal sclerotic lines affect the distal metaphyses of the radius and ulna, proximal metaphysis of the first metacarpal and distal metaphyses of the 2nd to the 5th metacarpal bones, bilaterally. Similar involvement is also observed in the visualized portion of the phalanges.
In addition, regarding the appearance and size of the secondary bone ossification centers, bone age is estimated at about 14 years, which indicates a delay in the patient's bone growth according to the chronological age.
Case Discussion
This case demonstrates a typical zebra stripe sign usually seen due to cyclical bisphosphonate therapy, e.g. pamidronate disodium (the diagnosis was established clinically).
Alternating radiolucent and radiodense metaphyseal lines also can be seen with several conditions, including rickets, especially those on prolonged treatment, e.g. vitamin D-dependent rickets, osteopetrosis, chemotherapy, chronic anemia e.g. sickle cell anemia and thalassemia, and treated leukemia.
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