Abstract
IntroductionBone metastases presenting with pain and body-ache may be the first presentation of carcinoma in about a fourth of patients with cancer. Radiologically majority of the metastases are osteolytic and multiple. Sometimes these may be confused with infective or inflammatory conditions, particularly in young individuals, and degenerative conditions of the spine and hip in elderly, which may delay the diagnosis and treatment leading to poor outcomes.Case presentationA 30 year old non-smoking male teetotaller presented with intermittent, high-grade nocturnal fever with night sweats of one year. He also had low back ache over his right hip. We found him febrile, pale and his long bones, ribs and pelvis were tender. He had a 3 × 4 cm tender and hard swelling over the upper part of his sternum. Another firm, non-tender swelling about 4 × 5 cm was seen in the right iliac region. Radiographs of the skull, spine and pelvis revealed multiple variable sized lytic lesions. A metastatic malignancy or disseminated tuberculosis was considered. His anti-tubercular therapy was intensified Fine needle aspiration from sternal lesion showed inflammatory cells. A bone marrow biopsy showed infiltration by tumor cells suggestive of metastatic adenocarcinoma. Patient's condition continued to deteriorate and he died within a fortnight of his hospitalization.ConclusionAlthough masquerading as tuberculosis lytic lesions might be an evidence of malignant metastatic. Although, treatment is ineffective in this stage palliative efforts to improve quality of life should be made.
Highlights
Bone metastases presenting with pain and body-ache may be the first presentation of carcinoma in about a fourth of patients with cancer
Several tumors like lung (10%), renal cell (10%) thyroid (5%) and adenocarcinoma (5%) are associated with osteolytic lesions, breast
MhiFnyigagpguioniretneotiec2tnhrseeessomancarasunsmcles(iaimorrnaogiiwnnvg)o(lMvinRgI)thTe1Wrigh(at)ilimacabgeonsehoewxtseandMagnetic resonance imaging (MRI) T1W (a) image shows a hypointense mass lesion involving the right iliac bone extending into the sacrum
Summary
Multiple lytic lesions are a common radiological finding. Differential diagnoses are diverse and include infective, inflammatory and primary and metastatic malignancies. A 30 year old non-smoking male patient presented with intermittent, high-grade nocturnal fever with night sweats of one year He had low back ache over his right hip. No change in symptoms was observed during one year of therapy and he lost 10 kg weight He developed a tender swelling over sternum about a month before presenting to us. T1 weighted MRI images of pelvis (Fig 2a) revealed a hypointense mass lesion involving the right iliac bone extending into the sacrum (arrow). T2 weighted MRI images (Fig 2b) revealed that the lesion in right iliac bone was hyperintense (double arrows). CT scan of chest (Fig 3b and 3c) showed the lung masses (solid arrows) and lytic lesions were observed in the sternum and the vertebra (double arrows). Patient's condition continued to deteriorate and he died within a fortnight of his hospitalization
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