Seropositive Rheumatoid Arthritis with Very Unusual X-ray Findings

We described the case of a 23-year-old Nepalese man with seropositive rheumatoid arthritis and abnormal x-ray findings, found to be due to a very rare bone disease: Camurati Engelmann disease or progressive diaphyseal dysplasia (PDD). This is the first case reported in the Gulf area, although approximately 300 cases have been described worldwide. These patients usually present with limb pain and easy fatigability. Our patient first presented with bilateral, symmetrical inflammatory polyarthritis involving the knees, ankles and wrists but sparing the hands and feet. The diagnosis of PDD in our case was based on the classic radiological findings and a bone scan. LEARNING POINTS: Rheumatoid arthritis is a common condition with typical radiological findings. Any unusual radiological finding should be carefully assessed and explained. In our case the unusual findings were due to progressive diaphyseal dysplasia.