Critical role of STIR MRI in early detection of post-streptococcal periostitis with dysproteinaemia (Goldbloom's syndrome).
OBJECTIVE
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.
2nd Department of Paediatrics, Giannina Gaslini Institute, and University of Genova, Italy. papariccardo86@gmail.com.
Riccardo
R
Papa
2nd Department of Paediatrics, Giannina Gaslini Institute, Genova, Italy.
Alessandro
A
Consolaro
2nd Department of Paediatrics, Giannina Gaslini Institute, Genova, Italy.
Francesca
F
Minoia
2nd Department of Paediatrics, Giannina Gaslini Institute, Genova, Italy.
Roberta
R
Caorsi
Service of Radiology, Giannina Gaslini Institute, Genova, Italy.
Gianmichele
G
Magnano
2nd Department of Paediatrics, Giannina Gaslini Institute, Genova, Italy.
Marco
M
Gattorno
2nd Department of Paediatrics, Giannina Gaslini Institute, and University of Genova, Italy.
Angelo
A
Ravelli
2nd Department of Paediatrics, Giannina Gaslini Institute, Genova, Italy.
Paolo
P
Picco
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D042241:Early Diagnosis; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000382:microbiology; D006801:Humans; D006942:Hypergammaglobulinemia / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D034141:Hypoalbuminemia / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D010522:Periostitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D011237:Predictive Value of Tests; D011241:Prednisone / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D013577:Syndrome; D013977:Tibia / Q000000981:diagnostic imaging* / Q000382:microbiology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D011241:Prednisone