PMC7792877_01
Magnetic resonance imaging with hyper intensity in anterior and posterior compartment in both hip and thigh (right > left) in short tau inversion recovery
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F1
Magnetic resonance imaging (MRI) showed hyperintensity in the anterior and posterior compartment in both thighs (right > left) and also in paraspinal muscles in short-tau inversion recovery [Figure 1].
Magnetic resonance neurography with multi located collection in right gluteus muscle and right femur neck osteomyelitis
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F2
Thereafter, magnetic resonance neurography (MRN) was ordered, which showed multilobulated collection in the right gluteus muscle and right femur neck osteomyelitis; however, lumbosacral nerve roots were normal [Figure 2].
Magnetic resonance imaging with Gadolinium with enhancement of paraspinal muscles in second visit
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F3
In second lumbosacral MRI with Gadolinium enhancement of paraspinal muscles was reported [Figure 3].
Magnetic resonance imaging in hip, thigh with hyperintensity in proximal muscles particularly in right side with avascular necrosis in right femur neck in second visit
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F4
In MRI of hip and thigh, hyperintensity in proximal muscles, particularly in the right side with avascular necrosis in the right femur neck, was noticed [Figure 4].
Magnetic resonance imaging in leg with hyperintensity in anterior and posterior muscles in leg
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F5
In addition, hyperintensity in anterior and posterior muscles in leg MRI was presented [Figure 5].
(a) Muscle biopsy right vastus lateralis with severe necrosis (a and b) and left sural nerve biopsy with mild wall thickening in vessels without infiltration (c and d)
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F6
In muscle biopsy, severe necrosis was displayed, and in left sural nerve biopsy, a mild wall thickening in vessels without infiltration with no evidence of vasculitis was shown [Figure 6].
Facial image of patient showing blue line on gums
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F7
In retrograde examination, blue line in gum of the teeth was detected [Figure 7], and the patient was referred to poisoning specialist, and penicillamine (500 mg q8h) with pyridoxine (50 mg daily) for 8 months was started for him.