Pauline, 32, had a rare condition called
Letterer-Siwe disease which stunted her growth so she is only 4ft 10in.
The differential was given as osteomyelitis, which was considered unlikely because of the sharp margins, hemangioma, and histiocytosis, or
Letterer-Siwe disease. A bone scan, which was obtained to assess the possibility of disease in multiple bones, showed increased uptake in the right mandible only (Figure, left and right).
This disease is a spectrum of three sub-types including eosinophilic granuloma, hand-schuller-christian disease and
letterer-siwe disease. We are presenting a case of 6 year old twin brothers who came with complaints of multiple painless swellings over the scalp.