Figure 1.

Patient 1 (a) at the age of 3 years and his older brother (Patient 2) (b) at the ages of 8 and 11 years both showing minor facial dysmorphic features: bulbous nose and frontal bossing. The younger patient (a) had joint contractures in both hands and feet. The older one (b) suffered from painful subcutaneous nodules in the plantar area and tendon restrictions in the hands. Radiographs demonstrate bone loss, wide metacarpals, and metatarsal bones