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ISSN: 2165-8048
Internal Medicine: Open Access
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Untreated Paget's Disease with Severe Bone Lesions

Suleyman Baldane1*, Gonca Kara Gedik2 and Levent Kebapcilar1
1Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Selcuk University, Konya, Turkey
2Department of Nuclear Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
*Corresponding Author : Suleyman B, MD
Department of Internal Medicine
Division of Endocrinology and Metabolism
Faculty of Medicine, Selcuk University, Konya, Turkey
Tel: +903322244685
E-mail: baldane42@hotmail.com
Received April 15, 2015; Accepted May 22, 2015; Published May 30, 2015
Citation: Baldane S, Gedik GK, Kebapcilar L (2015) Untreated Paget's Disease with Severe Bone Lesions Intern Med 5:102. doi: 10.4172/2165-8048.1000i102
Copyright: © 2015 Baldane S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Keywords
Paget’s disease, bone lesion, skull involment
A 65-year-old woman presented with a long-standing history of chronic back pain, and difficulty walking. During the last three years her relatives have realized a progressive hearing loss on her right and left side, as well as some facial changes, especially an enlargement of her mandible and an abnormal skull shape. A comprehensive metabolic panel with liver function tests, serum protein electrophoresis and growth hormone axis were normal. Serum alkaline phosphatase was markedly elevated at 3487 U/L (reference range 25-100) with normal levels of calcium 9.8 mg/dL and 25-hydroxyvitamin D 32 ng/mL. A bone scan with technetium-99 showed increased radiotracer uptake at various bony sites, including the T3, T6, T11 and T12, L3-L5 vertebrae, sacrum, pelvis, sternum and tip of the left scapula and skull reflects the increased bone turnover in Paget's disease (Figure 1). In addition, the x-ray pelvic film shows mixed lytic and sclerotic changes consistent with Paget’s disease (Figure 2). Radiography of the skull revealed thickening of the cranial bones, widening of the diploe and the “cotton wool” appearance caused by irregular areas of multiple osteolytic and osteosclerotic areas diffusely scattered throughout the skull (Figure 3). MR images of the skull confirmed bony expansion, cortical bone thickening (35 mm) and irregular areas of sclerosis (Figure 4).
Paget’s disease is primarily affect axial skeleton but these degrees of bone changes are not commonly seen today on account of earlier diagnosis.
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