A 10-year-old girl presented with a 1-year history of an eruption on her hands. Physical examination revealed soft, bluish slightly tender subcutaneous nodules and swellings in the ulnar site and palmar aspect of five fingers of the right hand and dorsal aspect of three fingers of the left hand without any gross deformity in fingers and long bones (figure 1). History of pathological fractures was negative. X ray of the right hand showed reduction in bone density with lytic lesions in five metacarps and proximal phalanx of the fourth and fifth fingers associated with soft tissue swellings (figure 2). A biopsy specimen was taken from a skin nodule (figure 3).