Infantile cortical hyperostosis is a self-limiting inflammatory disorder of infants with a triad of soft tissue swelling, bone lesions on x-ray and irritability. The bone involvement is usually asymmetrical and includes predominantly mandible, ribs, clavicle and long bones like tibia, ulna, and femur.
The baby at presentation had mild fever, raised TLC and ESR and pain in the left thigh, combined with x-ray findings of periosteal reaction was initially thought to be osteomyelitis. After the 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. The patient's radiographs after 6 months, at 11 months of age, were perfectly normal.