Multiple brown tumor revealing primary hyperparathyroidism associated with Behçet’s disease: A case report

Abstract

BackgroundPrimary hyperparathyroidism (PHP) is defined as hypercalcemia that may remain asymptomatic for years and cause lesion in skeletal system such as brown tumor (BT). Endocrine involvement in Behçet’s Disease (BD) regarding various systems can be seen. Case reportWe report an association between BD and PHP in a 45-year-old female. She had complained of inflammatory pain in the lower limb. Plain x-ray showed a lytic lesion on the upper tibia. Laboratory investigations revealed hypercalcemia (3.32 mmol/L), hypophosphatemia (0.48 mmol/L), a high parathyroid hormone (PTH) level (2278 pg/L) and a low vitamin D level (8.1 μg/L). An adenoma in the right lower parathyroid has been shown on scintigraphy, a vertebral fracture was present on lumbar spine X-ray and salt and pepper skull was shown on the lateral skull X-ray. Severe osteoporosis was present on the lumbar bone mineral density (t score −3.3), and multiple BT were revealed on bone scan. The patient was operated on and developed Hungry Bone Syndrome (HBS) following surgery. Therefore, she received high doses of calcium with favorable outcome. ConclusionThis case is a leading report for the coexistence of BD with PHP. This case provides further evidence that BD should be considered as an autoimmune process, which may be associated with endocrine involvement including PHP. On the other hand, musculoskeletal manifestations of PHP including BT still seen in daily practice require continued vigilance on the part of the physician.