An 8-year-old boy was admitted to our pediatric department because of intermittently fever spikes and widespread bone pain, especially in the lower limbs, with increased inflammatory markers and without relief after antibiotic and cortisonic therapies.
The physical examination showed multiple micro lymphadenopathies and bone pain advocated by digital pressure especially on tibial meta-diaphysis No history of trauma was reported. Laboratory tests confirmed increased inflammatory markers, thrombocytosis and hypergammaglobulinemia and high streptolysine O and DNase-B antibody levels. X-ray examinations of both legs and abdominal ultrasound resulted normal.
Whole-body MRI showed focal and symmetrical hyper intensity in STIR (Fig 1c) and hypo intensity in T1 (Fig 2c) sequences clearly evident on the distal tibio-peroneal meta-diaphysis bilaterally. Furthermore humerus, distal and proximal metaphysis of radius, proximal metaphysis of femur, tibia, fibula, tarsal navicular, cuneiform, III and IV metacarpi were involved. No hepatosplenomegaly.
Infectious and haemato-oncological diseases were excluded after further diagnostic investigations.
The clinical presentation (intermittent fever and widespread bone pain with complete intercritical well-being), laboratory tests and radiological pattern with the characteristic "sock’s sign" at the WBRMI, suggested a case of Goldbloom’s syndrome.
Therefore, steroid treatment was started with oral prednisone, leading to a rapid resolution of the clinical picture and progressive negativization of the inflammatory markers. The follow-up WBMRI, performed after 2 months, showed significant reduction of the hyper intensity on previously reported locations and disappearance of the “sock’s sign” on the distal metaphysis of tibias (Fig 3c).
Goldbloom’s syndrome is a pediatric idiopathic disease characterized by transient bone marrow edema with recurrent crisis of bone pain, periosteal hyperostosis, fever, increased inflammatory markers and dysproteinemia after GAS infection. The sock’s sign, in STIR-WBMRI, is a new radiologic sign pathognomonic of Goldbloom's Syndrome.
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