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A 33-year-old woman with a history of hypothyroidism and celiac disease presented with symmetric inflammatory polyarthritis. She had no history of seizure. She presented with multiple angiofibroma on the left side of the face and in the back (Figure 1a, b) with bone cysts in phalanxes, which were indicative of tuberous sclerosis with normal neurologic findings. Kidney ultrasonography showed cortical nephrocalcinosis. We observed shortening of the third metacarpal of the left hand during physical examination and radiography (Figure 2a, b). Inflammatory tests showed positive ANA=39.1 IU/mL (using ELISA with normal range <20), CRP: 3+, and ESR: 52. She had no history of hand trauma or surgery. After full evaluations and treatment of arthritis, the patient was discharged symptom free with normal inflammatory markers.

Unilateral shortening of third metacarpal bone in a patient with tuberous sclerosis