Category: Calcium/Bone Disorders
Objective : To present a case of Paget's bone disease with a polyostotic presentation.
Methods : The clinical and paraclinical features of the patient are presented
Results : Woman, 65 years old, from Lima with a history of trigeminal neuralgia for 9 years receiving carbamazepine, cervical cancer (2002) treated with brachytherapy and radiotherapy. For the past two years he has presented a history of pain in the spine (dorsal-lumbar) and in the left hip of moderate intensity, intermittent and progressive at rest, worsening with movement, which partially resolves with analgesics. A scintigraphy was ordered that reports multiple bone involvement to be considered secondary; During his hospitalization, pain is evident at the acupressure at the level of vertebrae L2 - L4. Upon palpation, there is an increase in bone volume at the level of the left anterior superior iliac spine, compared with the right. Analytical: blood count, CRP, biochemical profile, electrolytes including calcium and uric acid within normal parameters. In addition, it has alkaline phosphatase: 225 (45-120) being the remainder of normal liver profile, electrophoretic protein in blood: normal; IPTH: 28.60 (11-67), DHL: 239 (120-246), Ca125: 11.2 (0-35); AFP: 9.46 (0-10.9); B2 microglobulin: 1.35. The bone scan showed areas of sclerosis involving the iliac body, left ilio-pubic and ilioischial branch, TEM of the spine with a discreetly sclerous appearance in L3-L5 and sclerous bone lesion of the left iliac wing with coarse trabeculation and relative volumetric increase. The review of bone scintigraphy showed areas of uptake at the level of the right lower jaw, L5 vertebra and at the level of the left hemipelvis. She underwent a bone biopsy, showing thickened bone trabeculae and irregular cementing lines, secondary to a repetitive bone remodeling process compatible with bone Paget's disease. The patient was discharged after receiving EV doses of zoledronic acid with clinical improvement and alkaline phosphatase normalization evident at follow-up.
Discussion : Paget's disease of bone is a common disease in Western Europe, North America, Australia and New Zealand. In the patient, the diagnosis of Paget's Disease of bony polyostotic presentation to bone pain, trigeminal neuralgia, elevated alkaline phosphatase and the imaging findings of multiple sclerotic processes is considered; In the face of a cancer history, the biopsy confirmed our suspicion.
Conclusion : The presence of Paget's disease of bone in elderly patients with single and multiple bone lesions should be considered
Jose PAZ-IBARRA– ENDOCRINOLOGIST, HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU, Lima, Lima, Peru
Maria Trujillo– ENDOCRINOLOGY RESIDENT, HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
Hector Bojorquez– Resident of internal medicine, Hospital Rebagliati, Lima, Peru
HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU
Lima, Lima, Peru
PERUVIAN ENDOCRINOLOGIST, UNIVERSITY TEACHER, ACTIVE MEMBER OF AACE, AREAS OF INTEREST NEUROENDOCRINOLOGY, THYROID, ENDOCRINOLOGY OF REPRODUCTION AND BONE MINERAL METABOLISM
HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
RESIDENT OF ENDOCRINOLOGY WITH INTEREST IN CONTINUING LEARNING