Polyostotic fibrous dysplasia without craniofacial involveme
Published in the Journal of Scientific Society, the authors present a case of polyostotic FD without craniofacial involvement.

A 7-year-old male child presented with pain and swelling of the right lower limb along with difficulty in walking for 2½ months. The pain and swelling in the right lower limb were preceded by fall over the right ankle joint while walking. There was no apparent internal or external bleed.

On examination, vitals were stable, and general and systemic examination was normal. On local examination, tenderness was present over the proximal and distal parts of the right lower limb. Fundus examination revealed macular choroiditis of the left eye. Keeping in view testicular volume <4 ml and no pubic hair, patient was categorized as Tanner Stage 1.

Laboratory investigations revealed hemoglobin 11.4 g/dl, total leukocytes count 5400/μl, erythrocyte sedimentation rate 10 mm in 1st h, serum calcium 9 mg/dl, serum phosphorus 4.7 mg/dl, serum alkaline phosphatase (ALP) 261 U/L, serum 25-hydroxyvitamin D 15.95 ng/mL, serum blood urea nitrogen 10 mg/dl, serum creatinine 0.2 mg/dl, and serum prolactin 8.89 ng/mL.

X-rays revealed radiolucent lesions in metaphyseal ends of the right femur, right tibia. X-rays of the left side of the appendicular skeleton, skull, and chest were within normal limit. CT scan of the right leg was suggestive of multiple cystic lesions involving the metaphyseal ends of right tibia and femur with well-defined sclerotic margins, endosteal scalloping, but no periosteal reaction, so kept the possibility of polyostotic FD.

Injection pamidronate at 1 mg/kg was given over 3 days and repeated every 3 months. Calcium and Vitamin D (1000 mg and 6 lakh U) were also started after giving the injection pamidronate. All these interventions resulted in significant improvement in this child without any adverse effects.

Key learnings:-
- FD is asymptomatic, it can be noticed incidentally in cone beam CT, CT scans, and radiographs. If there is no symptom or evidence of progression during follow-up, surgical treatment is not considered.

- Surgical intervention is reserved for the prevention and treatment of fractures and major deformities.

- Pamidronate has been successful in the treatment of Paget's disease, malignant hypercalcemia, lytic bone metastases, multiple myeloma, and osteoporosis.

- Recurrence of FD is rare when the lesion has occurred in adults, but it is seen more commonly in growth period.

- The patients who had FD have higher ALP; this may be a reliable marker for estimating tumor progress. This patient showed promising results with pamidronate therapy without any side effect.

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