Chronic non-bacterial osteitis presenting with upper limb deep vein thrombosis: diagnostic clues and therapeutic considerations

Journal of Bone and Mineral Research, vol. 41, pp. 799–803

Abstract

A 40-yr-old Scandinavian man with a 10-yr history of palmoplantar pustulosis presented with left upper limb swelling and was diagnosed with a deep vein thrombosis. Imaging revealed subclavian vein compression due to marked clavicular hyperostosis. The patient reported longstanding sternoclavicular pain, inflammatory back pain, and electronic health records review showed persistently elevated inflammatory markers. CT demonstrated extensive cortical overgrowth of the clavicle consistent with chronic non-bacterial osteitis (CNO), alongside thoracic syndesmophytes suggestive of axial spondyloarthritis-like involvement. Long-term anticoagulation was initiated, and rheumatology assessment confirmed CNO. TNF inhibition therapy was started to control the inflammatory symptoms. This case highlights a rare but serious complication of CNO: thoracic outlet obstruction with secondary thrombosis from progressive bone overgrowth. Earlier recognition might have prevented irreversible structural and vascular sequelae. It also underscores current uncertainties in CNO management, including whether treatment can prevent hyperostosis, how to identify high-risk patients, and the optimal duration of treatment.

Authors 5

1. Nina Thomson

   University of Edinburgh

   Affiliation as printed

   Medical School, University of Edinburgh , EH8 9AG Edinburgh ,

2. Jack Leese

   NHS Lothian

   Affiliation as printed

   Rheumatology Department, NHS Lothian , EH4 2XU, Edinburgh ,

3. James Bott

   NHS Lothian

   Affiliation as printed

   Radiology Department, NHS Lothian ,EH4 2XU, Edinburgh,

4. Elizabeth Martha Winter Aachen Center for Bone Quality Department of Internal Medicine Division of Endocrinology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Center for Bone Quality, Leiden University Medical Center , 2333 ZA, Leiden ,

   Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center , 2333 ZA, Leiden ,

5. Barbara Hauser corresponding

   University of Edinburgh · NHS Lothian

   Affiliation as printed

   Centre for Genomic and Experimental Medicine, IGC, University of Edinburgh , EH4 2XU Edinburgh ,

   Rheumatology Department, NHS Lothian , EH4 2XU, Edinburgh ,