TY - JOUR T1 - Osteolytic Lesion in PAPA Syndrome Responding to Anti-interleukin 1 Treatment JF - The Journal of Rheumatology JO - J Rheumatol SP - 2333 LP - 2334 DO - 10.3899/jrheum.140060 VL - 41 IS - 11 AU - ROBERTA CAORSI AU - PAOLO PICCO AU - ANTONELLA BUONCOMPAGNI AU - ALBERTO MARTINI AU - MARCO GATTORNO Y1 - 2014/11/01 UR - http://www.jrheum.org/content/41/11/2333.abstract N2 - To the Editor:Born from an uneventful pregnancy and in complete well-being, a girl at the age of 18 months presented arthritis of the left knee associated to low-grade fever, leukocytosis, and increased inflammatory markers. The arthrocentesis revealed turbid fluid with a negative culture. The girl was treated with intravenous antibiotic therapy with a temporary partial improvement, but pain and swelling of the left knee recurred and worsened in the subsequent months. Pain at the lower left limb was also referred without signs of arthritis at the ankle. Radiograph of the lower limbs was performed revealing the presence of an osteolytic area of about 2.3 cm × 0.7 cm with periosteal apposition in the distal diaphysis of the left tibia. Bone scintigraphy showed a metabolic hyperactivity in the same area only. Bone biopsy was negative for malignancy, histiocytosis, or tuberculosis while revealing the presence of an inflammatory infiltrate with neutrophils, macrophages, and monocytes, consistent with a diagnosis of chronic osteomyelitis. Nonsteroidal antiinflammatory drug treatment was started, with poor response. Bone marrow … Address correspondence to Dr. Marco Gattorno, MD, UO Pediatria 2, Istituto Giannina Gaslini, Largo Giannina Gaslini 5, 16147, Genoa, Italy. E-mail: marcogattorno{at}ospedale-gaslini.ge.it ER -