Page 45 - JCTR-9-4

Journal of Clinical and Translational Research 2023; 9(4): 261-264

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

CASE REPORT

A rare case of asymptomatic Paget’s disease of the skull in a 60-year-old

Asian female

Muhammad Ali *, Omama Farooq , Zahra Rafique , Hajrah Farooq , Fazeelat Iftikhar , Muqadsa Malik 2
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1 Department of Internal Medicine, Islamabad Medical Complex, NESCOM Hospital, Islamabad, Pakistan, Department of Internal Medicine, Fauji
Foundation Medical College, Rawalpindi, Pakistan
ARTICLE INFO ABSTRACT
Article history: Background and Aim: Paget’s disease of the bone refers to a chronic cumulative disorder
Received: November 05, 2022 characterized by enhanced osteoclastic function followed by a secondary surge in osteoblastic activity.
Revised: January 22, 2023 The condition can manifest as a polyostotic or monostotic bone disease with most patients having an
Accepted: May 30, 2023 asymptomatic presentation, although some may complain of pain localized to the affected bone while
Published online: July 26, 2023 others express symptoms of nerve compression. A pagetic bone is predisposed to develop pathological
fractures, bony deformities, and a rare yet detrimental transformation into osteosarcoma. Detection
Keywords: is often accidental when performing radiographic tests for other indications or when elevated blood
Alkaline phosphatase levels of alkaline phosphatase (ALP) are detected. Treatment with third-generation bisphosphonates
Paget’s disease of bone is helpful in preventing further bone resorption and, additionally, reduces bony pains that are believed
Osteitis deformans to be caused by excessive metabolic activity. Here, we present a case of a middle-aged asymptomatic
Tc-99m-methylene diphosphonate female with elevated serum ALP levels up to 1537 IU/L (reference range 40–150 U/L) during her pre-
Bisphosphonates operative evaluation for elective cholecystectomy. 99m Tc-methylene diphosphonate bone scintigraphy
revealed diffuse uptake in the skull and, hence, was diagnosed as a case of isolated Paget’s disease of
*Corresponding authors: the skull.
Muhammad Ali Relevance for Patients: The rarity of this disease in Southeast-Asians, its uncontrived detection,
Department of Internal Medicine, Islamabad and the isolated skull involvement, imparts high clinical relevance on this case. Early detection and
Medical Complex, Nescom Hospital, management of this disease can help prevent the development of life-threatening complications in
Islamabad, Pakistan. affected patients, hence decreasing the morbidity.
Tel: +92 345 5240908
Email: muhammad.ali.janjua93@gmail.com

© 2023 Author(s). This is an Open-Access 1. Introduction
article distributed under the terms of the
Creative Commons Attribution-Noncommercial Paget’s disease of bone (PDB), also known as osteitis deformans, is a chronic skeletal bone
License, permitting all non-commercial use, disorder characterized by focal areas of excessive disorganized bone remodeling, targeting
distribution, and reproduction in any medium, any bone throughout the skeleton. This disease primarily affects the axial skeleton, where
provided the original work is properly cited.
pelvis is the most common site of involvement, followed by femur, lumbar spine, skull,
and tibia [1]. Most patients are asymptomatic and often present with an incidental finding
of high serum alkaline phosphatase (ALP) levels during routine blood examination [2].
Diagnostic modalities commonly utilized include X-ray, biochemical analysis of serum
total ALP, computed tomography (CT) scan, bone scintigraphy, and magnetic resonance
imaging [3].
2. Case Presentation

A 60-year-old Asian female with a known case of hypertension and treated hepatitis C
virus infection presented to the surgical outpatient department for her scheduled pre-operative

DOI: http://dx.doi.org/10.18053/jctres.09.202304.22-00186