Melorheostosis: A Case Report on the Atypical Clinical Presentation and Management of a Rare Sclerosing Bone Disease

Melorheostosis, also known as Leri disease, is an exceptionally rare mixed sclerosing bone dysplasia of mesodermal origin, with a global prevalence below one per million individuals. It is characterized by progressive cortical and medullary hyperostosis following a sclerotomal distribution, producing the pathognomonic radiographic "dripping candle wax" appearance. We report a 50-year-old woman with no relevant medical background who presented with insidious left lower extremity pain, diffuse limb swelling, local warmth, hyperpigmentation, and reduced range of motion. Radiographs demonstrated eccentric cortical hyperostosis of the left tibia and fibula. Laboratory findings were entirely within normal limits, and tibial biopsy disclosed hyalinized collagen fibers with dystrophic calcifications. This case is notable for its late-onset presentation and monomelic distribution, contrasting with the early-onset course more commonly described. The patient achieved satisfactory outcomes through a conservative multimodal strategy combining celecoxib and structured physical therapy, with pain declining to 1/10 on the Visual Analogue Scale alongside meaningful functional recovery. This report highlights the importance of integrating clinical, imaging, and histopathological data, and reinforces the value of individualized, multidisciplinary management in this challenging condition.