Rare case of paget’s disease with co-existing features of ankylosing spondylitis

Abstract

Introduction: Paget’s disease is an uncommon metabolic skeletal disorder characterized by increased osteoclast-mediated bone resorption & compensatory excessive osteoblastic activation. It is often an incidental finding & can also rarely co-exist with other disorders like ankylosing spondylitis.Materials & Methods: Observational type of case study using computed tomography (CT) and X-Ray. 80 years old male came with complaints of giddiness & fall & decreased speech output. CT scans showed intraventricular hemorrhage & patient was treated for the same. However, CT scans revealed features suggesting Paget’s disease with co-existing ankylosing spondylitis & a bone survey for whole body was done. Increased S. Alkaline Phosphatase (187 U/L) & low Calcium (7.5 mg/dl) was noted.Results: CT Brain showed mixed lytic sclerotic changes with widened diploic space & coarse trabeculae involving calvarium fully giving a cotton wool appearance. Spine imaging revealed, picture framing of some vertebrae, anterior & lateral syndesmophytic fusion giving a bamboo spine appearance & diffuse osteopenia with multiple sclerotic areas. X-Ray pelvis showed of Kohler tear drop & sclerosis with near complete fusion of bilateral sacroiliac joints. Conclusion: Paget disease of bone shows an abundance of patterns on imaging that are related to pathologic stage of disease. Recognition of imaging spectrum usually allows early diagnosis & differentiation of its complications, which helps guide therapy & improve patient management.