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Bone changes from prostaglandin therapy
Insights
Prostaglandin E therapy in infants can cause periosteal elevation, a bone change visible as early as nine days. This condition may mimic Caffey disease but differs in bone involvement patterns.
Area of Science:
- Pediatric Radiology
- Neonatal Medicine
- Skeletal Dysplasias
Background:
- Prostaglandin E (PGE) is crucial for maintaining ductus arteriosus patency in neonates.
- PGE therapy can lead to various side effects, including bone changes.
Observation:
- Periosteal elevation, a bone response, was observed in infants receiving PGE therapy.
- These changes, typically seen in 30-40 days, were noted as early as nine days in some cases.
Findings:
- Three out of 15 infants on PGE therapy for over six days developed periosteal elevation.
- Long-term follow-up in two cases showed complete bone remodeling to normal.
- Gallium scans indicated increased uptake in affected areas, suggesting active bone response.
Implications:
- Periosteal elevation from PGE therapy can mimic other conditions like Caffey disease.
- Distinguishing PGE-induced changes from Caffey disease is important, as the mandible is rarely involved in PGE therapy but commonly affected in Caffey disease.
Abstract:
Prostaglandin E therapy in infants causes periosteal elevation. Although the changes usually take 30-40 days to become visible, we have seen them as early as nine days. In 15 infants who had prostaglandin E therapy for over six days, three developed periosteal elevation. Three other cases are described in greater detail, with long-term follow-up in two in which the bone remodeled to normal. Gallium scan in one showed increased uptake in areas involved. The periosteal cloaking may mimic Caffey disease but the pattern of involvement is different, since the mandible, which is commonly affected in Caffey disease, is rarely involved in prostaglandin E therapy.