PMC4472877_01
Frontal view of the child
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F1
A 7-year-old female child visited the depart ment of pedia-tric medicine with a chief complaint of swelling in the left ankle since 2 weeks (Fig. 1).
Charcot's joint
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F2
The condition was diagnosed as osteomyelitis of the left ankle (Charcot's joint, osteoarthritic neuropathy) (Fig. 2) and treatment was initiated for the left ankle.
Degenerated nails on the digits of the hands
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F3
The physical examination disclosed that the patient had dry skin and wounds along with degenerated nails on many of the digits of the hands (Fig. 3).
Restricted mouth opening
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F4
The mouth opening was restricted (27 mm) (Fig. 4).
Dental caries in relation to 54 and 64
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F5
The lower arch was edentulous except for the permanent first molars and decay was observed on 54, 64, 36 and 46 (Fig. 5).
Elli's class I fracture in relation to 11 and 21
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F6
The maxillary incisors showed Ellis class I fracture (Fig. 6).
Dental caries involving the pulp in relation to 36
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F7
Also, severe bone loss and dental caries involving the pulp in relation to 36 was noticed (Fig. 7).
Lateral cephalogram revealing the absence of tooth buds and severe mandibular prognathism
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F8
A lateral cephalogram taken to evaluate the maxillo-mandibular relationship revealed the absence of tooth buds and severe mandibular prognathism (Fig. 8).
Magnetic resonance imaging revealed no obvious abnormality in the development and the condition of the brain
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F9
Magnetic resonance imaging was advised by the department of neurology and pediatrics to assess the development and condition of the brain (Fig. 9).
Radiographs of the feet revealed Charcot's joint
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F10
Radiographs of the feet revealed Charcot's joint (Fig. 10).
Triple antibiotic paste filled in the pulp chamber and permanent restoration done for 36
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F11
So triple antibiotic paste was filled in the pulp chamber and a permanent restoration was done (Fig. 11).
Composite restoration of maxillary central incisors
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F12
Composite restorations were done for the fractured maxillary incisors (Fig. 12).
A full thick excision skin biopsy and a nerve biopsy being performed
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F13
Simultaneously, a full thick excision skin biopsy and a nerve biopsy were also performed to assess the severity of the condition (Fig. 13).
Orthokeratotic squamous epithelium with papillomatosis
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F14
The skin biopsy revealed orthokeratotic squamous epithelium with papillomatosis (Fig. 14) and dermis showing adnexal structures which did not show any nerve fibres (Fig. 15).