# Delayed Diagnosis of a Rare Case of Melorheostosis Affecting Both Upper Limbs

## TL;DR

A 35-year-old woman with a rare case of melorheostosis affecting both upper limbs was diagnosed and treated, showing improvement in symptoms over time.

## Contribution

This case report highlights a rare bilateral presentation of melorheostosis and its successful management.

## Key findings

- The patient showed improvement in pain and halted progression of swelling after treatment.
- Radiography confirmed the characteristic 'dripping candle wax' appearance of melorheostosis in both upper limbs.
- Treatment included zoledronic acid, NSAIDs, and other medications, leading to positive outcomes.

## Abstract

Melorheostosis is an uncommon sclerosing bone dysplasia that primarily affects the long bones on one side, and occasionally hands or feet. The unique radiographic appearance, resembling dripping candle wax on the affected bone, is typically used to aid in diagnosis.

We present a case report of a 35-year-old woman who had had several bony swellings in her right hand, right forearm, right arm, left hand, and right upper chest for 28 years, which were slowly progressive. The patient complained of dull, throbbing pain and restricted joint movement in the affected areas. Plain radiography revealed flowing hyperostosis, resembling dripping candle wax, involving multiple bones of both upper limbs, including the right scapula and clavicle. We diagnosed her as a case of melorheostosis involving both upper limbs. She was treated with zoledronic acid, non-steroidal anti-inflammatory drugs (NSAIDs), duloxetine, pregabalin, and ongoing calcium and Vitamin D supplementation. Subsequent follow-up visits at 3, 6, and 12 months showed improvement in pain, with a halt to the progression of swelling.