We report a case of a 47-year-old woman with isolated periostitis of the lower leg as a first manifestation of large vessel vasculitis. The diagnosis was first suspected when a second MRI of the lower leg approximately 4 months after onset of shin pain showed edema near intramuscular vessels. Isolated periostitis is a very rare skeletal manifestation of systemic vasculitis and could easily be misdiagnosed. This case demonstrates that maintaining a broad differential diagnosis for a common presenting complaint such as localized leg pain is imperative.
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