Revisiting melorheostosis: highlighting the classic dripping candle wax sign in a young female

Melorheostosis is a rare dysplastic bone disease that is typically diagnosed in radiographic studies. The pathogenesis of melorheostosis remains unclear, with many genetic pathways suspected to play a role. Melorheostosis is sporadic in nature, usually limited to a single limb, extending in a sclerotomal fashion, and no clear gender predilection has been proven in the literature. Multiple case reports have described the disease characteristics in adults and involving large bones. We present a case of a 16-year-old female patient who presented with right upper limb pain with swelling. Plain X-rays showed melorheostosis of the right upper limb, demonstrating the typical “dripping candle wax” sign. Further radiographic evaluation of the patients showed that the disease extended in a sclerotome distribution, including the humerus, radius, and second, third, and fourth metacarpals and phalanges. A literature search across PubMed, Scopus and the Directory of Open Access databases was conducted to study this disease in the young age group.