Second-year internal medicine resident Dr. Iiro Honkanen and (now) first-year ophthalmology resident Dr. Lauren Hock worked with Drs. Brittany Bettendorf and Wendy Fiordellisi (of the Divisions of Immunology and General Internal Medicine, respectively) to produce a brief case report and corresponding image that appeared in last month’s edition of Arthritis & Rheumatology, the official journal of the American College of Rheumatology. The foursome’s report, “Reactive Periostitis Due to Inhalant Abuse,” is dramatically enhanced by an accompanying photograph and X-ray, which earned placement in the journal’s “Clinical Image” monthly series.
The report and images provide a vivid insight into the effects of inhalant abuse, which ultimately resulted in the formation of new bone in the periosteum because of increased serum fluoride levels. “This was a highly unusual case,” senior author Dr. Bettendorf said. “Similar features can be seen with chronic use of the antifungal voriconazole, but to our knowledge this presentation has never been described as a result of inhalant abuse. ” She also described the benefit both to the larger scientific community as well as the two residents who worked on the article. “This case was a great learning experience for us. Sharing this case will benefit the greater rheumatologic and primary care communities by helping to identify this entity in other patients in the future.”