Critical role of STIR MRI in early detection of post-streptococcal periostitis with dysproteinaemia (Goldbloom's syndrome)

Clin Exp Rheumatol. 2017 May-Jun;35(3):516-517. Epub 2017 Mar 23.

Abstract

Objectives: In 1966, Goldbloom et al. described two children who developed a peculiar clinical picture characterized by intermittent daily bone pain in the lower limbs, fever spikes, increased acute phase reactants and dysproteinaemia. The syndrome occurred two weeks after a group A β-haemolytic streptococcus infection. So far, only a few cases have been reported in the medical literature in English.

Methods: We report two further cases of Goldbloom's syndrome with a review of the literature in English.

Results: Our two patients lived in the same Italian region and presented their syndrome onset a week apart. Early use of STIR MRI revealed an atypical metaphyseal hyperintensity in the femurs and tibias. X-ray showed periosteal hyperostosis. A short cycle of corticosteroids led to rapid recovery of symptoms and disappearance of bone changes.

Conclusions: The reported cases highlight a likely under-recognised post-streptococcal inflammatory periosteal reaction and emphasise the diagnostic utility of the newer imaging modalities.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Biomarkers / blood
  • Child
  • Early Diagnosis
  • Female
  • Femur / diagnostic imaging*
  • Femur / microbiology
  • Humans
  • Hypergammaglobulinemia / blood*
  • Hypergammaglobulinemia / diagnosis
  • Hypergammaglobulinemia / drug therapy
  • Hypergammaglobulinemia / microbiology
  • Hypoalbuminemia / blood*
  • Hypoalbuminemia / diagnosis
  • Hypoalbuminemia / drug therapy
  • Hypoalbuminemia / microbiology
  • Magnetic Resonance Imaging*
  • Periostitis / diagnostic imaging*
  • Periostitis / drug therapy
  • Periostitis / microbiology
  • Predictive Value of Tests
  • Prednisone / therapeutic use
  • Streptococcal Infections / complications*
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / microbiology
  • Syndrome
  • Tibia / diagnostic imaging*
  • Tibia / microbiology
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Biomarkers
  • Prednisone