LAUSR

An 11‐year‐old boy with short stature, the child of non‐consanguineous parents, presented with deformities of the left forearm and leg that were first noted by his parents at 6 months of age. His birth and developmental history were unremarkable. At 5 years of age, he underwent surgery for an equinovarus deformity of the left foot and one year later, developed nodules over the left palm and sole that have progressively enlarged over the past 2 years. The nodules bled occasionally with trauma or friction. On examination, a lobulated swelling was present over the the‐ nar eminence and thumb of left hand, comprising of discrete to con‐ fluent reddish blue‐black compressible nodules with increased girth of the thumb and broadening of the thumbnail plate. A reddish‐blue compressible nodule with a keratotic collar was present over the medial margin of heel of left foot with few discrete reddish papules anterior to the nodule (Figures 1 and 2). There was visible deformity of the forearms and legs with equinovarus deformity of left foot (Figure 3). Mucosal examination was unremarkable. Routine investigations revealed no abnormality. Serum parathor‐ mone, calcium, and phosphorous levels were normal. Skeletal sur‐ vey revealed multiple expansile lytic lesions with matrix calcification involving the medullary cavity of the tubular bones of the left half of the body. (Figure 4). A lobulated soft tissue mass without calcifi‐ cations or phleboliths was appreciated in the left hand. MRI of the left hand disclosed multiple small lobulated heterogeneous‐signal lesions in the subcutaneous and intermuscular planes involving the thenar region, thumb, index, and middle finger (Figure 5). Another similar but separate smoothly marginated hyperintense lesion was also noted in intermuscular plane of left mid forearm.