Of particular note, the periostitis extended to the ends of the long tubular bones in a pattern similar to primary hypertrophic osteoarthropathy (pachydermoperiostosis), which can be an autosomal dominant disorder affecting males more severely than females.(52) Autosomal recessive pachydermoperiostosis is the result of disturbances in prostaglandin metabolism due to deactivating mutations in the gene that encodes 15-hydroxyprostaglandin dehydrogenase.(53). The gene discussed is HPGD; the disease is hypertrophic osteoarthropathy, primary, autosomal recessive, 1.