Unusual Presentation of Osteoid Osteoma with Exacerbating Pain during Menses

Osteoid osteomas (OO) are benign neoplasms commonly present during the second and third decade of life, showing a male predominance with classical nocturnal bone pain dramatically responding to nonsteroidal anti-inflammatory drugs. We report a 22-year-old female patient who presented at a teaching hospital, Baghdad, Iraq, in 2023. She presented with right leg bone pain that was exacerbated during menstruation, a presentation that had never been reported in the literature before. The pain intensity increased and interfered with her daily activity. A computed tomography scan showed OO signs and surgical excision and histopathology confirmed OO. The patient's pain reduced to 0 on the visual analog scale. She has no recurrence signs 2 years after the surgery. This novel OO presentation may increase physician awareness of atypical presentation. A careful evaluation of a challenging presentation added to an imaging study may reveal the underlying cause and exclude other diagnostic dilemmas.