Combined Melorheostosis and Osteopoikilosis: Uncommon Presentation with Sciatic Nerve Neuropathy

CASE: A 27-year-old man presented with an 8-year history of chronic right gluteal and posterior thigh pain, worsened by sitting and unresponsive to conservative treatment. Imaging revealed widespread melorheostosis and osteopoikilosis of the right lower extremity, with 2 gluteal soft tissue masses compressing the sciatic nerve. The masses were excised using a dual surgical approach, achieving successful sciatic nerve decompression. Postoperatively, the patient regained normal sitting and sleeping tolerance, with complete pain relief maintained over a 15-month follow-up. CONCLUSION: Melorheostosis, a rare sclerosing bone disorder sometimes associated with osteopoikilosis, may require surgery when large lesions cause nerve compression.