OSTEOPIKILOSIS PUNCTATA – BENIGN SPOTTED DISEASE; A Case Report A Rare Cause of Bone Pain and Mimicker of Metastasis on Radiographs
Abstract
Aim: To describe Osteopoikilosis Punctata and its associated clinical and radiological findings.
Background: Osteopoikilosis (OPK), also referred to as spotted bone disease, disseminated condensing osteopathy, or osteopecilia, is a benign, autosomal dominant rare boney disorder characterized by sclerosing bony dysplasia and multiple benign enostoses. It usually presents as symmetrically distributed small, numerous, well-defined, homogenous circular radio densities that are clustered in the periarticular regions of the metaphysis and epiphysis of the long bones. However, few rare occurrences have been reported where they diffusely present throughout axial and appendicular skeleton. Radiologically they can be confused with metastasis. There is no gender and age predilection and are usually asymptomatic and found incidentally, however, in 15–20% of the patients, joint effusion is seen on inspection and slight juxta-articular tenderness is felt on palpation. Histological features are similar to bony islands and it may be associated with synovial osteochondromatosis, connective tissue disorders and a rare bone condition called melorheostosis.
Case Description: We present a case of OPK Punctata in a 27 years old male patient, presenting with complaints of mild bilateral shoulder pain and referred cervical region pain, which was non radiculopathy in nature. Upon radiological investigations (Plain radiography and CT scans), typical features of OPK punctata were noted but he was referred to our sarcoma service from abroad for expert opinion to exclude metastatic disease. After confirmation of diagnosis on radiology, his shoulder pain was managed along the lines of sub acromial impingement which completely settled within 03 months and he remains symptom free till last follow up.
Conclusion: Osteopikilosis may be an isolated finding or associated with other pathologies, e.g. skin manifestations, rheumatic and/or skeletal disorders. Due to its mimicking capability of other more severe conditions such as bone metastases and an extremely uncommon cause of bone pain, the main differential diagnosis is osteoblastic metastasis as per clinical correlation of the investigations.
Keywords: Osteopoikilosis, sclerosing bone dysplasia, osteoblastic metastasis, bone pain.
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