--- a
+++ b/data/text/es-S1889-836X2015000100003-1.txt
@@ -0,0 +1,3 @@
+Male patient referred in 2009 for monitoring to the Bone Metabolic Unit (BMU) at the age of 36 and diagnosed in a private centre with monostotic Paget's disease of the left radius. At the time, the patient provided a biopsy and scintigraphy report carried out in 2007. He was treated with risedronate at the dose used for osteoporosis. On observing the good result in the levels of P1NP (procollagen type 1 amino-terminal propeptide), risedronate was discontinued that same year, 2009. From then until November 2014, he was periodically monitored for serum levels of bone remodelling markers, and a new cycle of low-dose risedronate was prescribed for a few months when these increased. Also during this period of time, a scan was performed without finding any significant alterations with respect to the previous scan. When the treatment was administered, the patient's symptoms of local pain improved, but in November 2014 he spontaneously came to the clinic with his arm in a sling, reporting that two days earlier he had suffered a casual fall and presented intense pain in the area of the left carpus. Physical examination revealed a haematoma on the dorsum of the hand and distal third of the forearm, oedema, effacement of the tendon grooves on the dorsum of the hand, functional impotence of the wrist and a local increase in temperature. Given the clinical suspicion of fracture, the patient was referred from the Metabolic Unit to the Accident and Emergency Department where X-rays were taken; he was discharged with the diagnosis of contusion as no fracture was evident, but a large hyperostotic lesion was observed on plain X-rays, which is why the patient returned to the BMU. Despite the fact that the fracture was not visible on the X-rays, but there was clinical evidence of it, an urgent computerised axial tomography (CAT) scan and a nuclear magnetic resonance (NMR) scan were requested for a deferred study of the hyperostotic lesion. The CT scan showed a fracture of the hooked and trapezius bones. The limb was immobilised with a posterior splint. Once the traumatic emergency had been resolved, the radiological lesion of the radius was re-evaluated in the following days and the so-called "sliding wax melting" sign was identified. Given the possibility of melorheostosis, this option was discussed with the Radiology and Nuclear Medicine departments for their consideration. Finally, this was accepted as an alternative diagnosis to Paget's disease of bone, being indistinguishable gammagraphically. Once the new diagnosis of melorheostosis had been confirmed and agreed, we went back to the anamnesis, which included a report of a fall at the age of 14 while practising sport. The patient reported having suffered intense pain in the radius, but did not go to any health centre and hid it from his parents, presenting a certain deformity since then. The pain subsided weeks after the fall. We deduce that the patient fractured his radius and as the fracture was not immobilised or reduced, he was left with the deformity that can be seen in figure 1, but which is not directly related to the hyperostosis. In addition to the striking central image, there are other areas of hyperostosis on the inside of the distal end of the radius and in the proximal third.
+
+