This he discovered in a patient with chronic periostitis of the tibia. No evidence was found of stress fracture or infectious processes like osteomyelitis or infectious periostitis. This causes pain at night and thickening of the affected bones (periostitis). The shinbones may become bowed (saber shin) from chronic periostitis. A similar situation arose some months later, when Berger himself was afflicted by dental periostitis. Alternatively, histology should show periostitis, osteitis, meningitis and ganglioneuritis. The bony lesions are followed by periostitis, with permanent deformation of the facial bones. Congenital infection with syphilis can also cause periostitis in newborn infants. Periostitis has also been documented in the shoulder blade of a ceratopsian. Radiographic imaging of affected extremities typically demonstrates periostitis, most commonly the metacarpal bones.