Multiple osseous lesions in children are rare and suggest the possibilities of Langer-hans cell histiocytosis (LCH), malignancies, enchondromatosis, multifocal osteomyelitis, and tuberculosis [1]. We present a 12-year-old boy with fever for 7 months and pain in the lower back and left hip joint for 5 months, with multiple sclerotic, lytic, and mixed osseous lesions in the axial and appendicular skeleton (see Figure 1). He had received antitubercular treatment for 5 months for suspected tuberculosis of the spine, with no clinical improvement. Aspirin and methotrexate prescribed for suspected juvenile rheumatoid arthritis had provided no relief of symptoms. He had no history of recurrent infections. His HIV was negative by ELISA and his serum immunoglobulin levels were normal. There was no palpable lymphadenopathy or organomegaly. Bone marrow examination was normal.
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