Background: Physiologic periostitis (PP) is characterized by periosteal reaction without any inflammatory condition, and with a more common presentation in pediatric age group involving long bones. It can easily be misinterpreted for a pathological process due to asymmetrical presentation in some cases. 99mTc-methylene diphosphonate (MDP) bone scintigraphy is one of the effective tools for its diagnosis as it helps to localize multiple lesions in the whole skeleton. Case Presentation: A male child, 1 month of age, was referred to the nuclear medicine department of our hospital with swelling involving the right hip for 2 weeks with no history of fever and trauma. There was a mild skin discoloration at the site of swelling along with restricted leg movements. The 99mTc-MDP bone scan (BS) showed abnormal increased uptake in the proximal and distal ends of the right femur along with increased uptake in proximal right humerus. X-ray images showed periosteal reaction involving diaphyseal ends of respective long bones, and these findings together with the patient’s history and normal biochemical profile suggested the presence of PP in this case. The patient’s condition was improved later after treatment with non-steroidal antiinflammatory drugs (NSAIDs), thus confirming our diagnosis. Conclusion: PP is one of the differential diagnoses in children presenting with pain or swelling in upper or lower limbs. As the condition is self-limiting, it is important to accurately diagnose this condition before subjecting the child to vigorous testing and treatments. Exceptional behavior of this condition on BS should also be kept in mind.

Keywords: 99mTc-MDP bone scan, X-rays, physiological periostitis, case report