Infantile cortical hyperostosis

Case contributed by Dr Nafisa Shakir Batta

Presentation

5 month baby - irritable, mild fever, tenderness left thigh with visible swelling, was undergoing treatment for osteomyelitis.

Patient Data

Age: 5 months
Gender: Male

On admission

Modality: X-ray
Lamellated to fusiform periosteal reaction along the shaft of left femur is evident with minimal soft tissue swelling. A subtle finding of periostitis along the right lower ribs is also seen, and child cried everytime he was held due to chest pain.

Three week follow-up (new complaint jaw swelling)

Modality: X-ray

Baby now had a visible jaw swelling. xrays of mandible showed minimal periostitis. Xray of left thigh and chest AP view showed negligible decrease in periosteal reaction.

Case Discussion

Infantile cortical hyperostosis is a self limiting inflammatory disorder of infants with triad of soft tissue swelling, bone lesions on x-rays and irritability. The bone affection is usually asymmetrical and include predominantly mandible, ribs, clavicle and long bones like tibia, ulna, and femur.

Baby at presentation had mild fever, raised TLC and ESR and pain at left thigh, this combined with x-ray findings of periosteal reaction was initially thought to be osteomyelitis. Post antibiotic therapy, TLC continued to be mildly raised, pain and swelling subsided only minimally, with a new development of jaw swelling.

Repeat x-rays and this clinical scenario were pathognomonic of Caffey disease.

A bone biopsy was done and confirmed the diagnosis. Patient's x-rays post 6 months at 11 months of age were perfectly normal.

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Case Information

rID: 25032
Case created: 29th Sep 2013
Last edited: 11th Aug 2016
Inclusion in quiz mode: Included

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