case of vitamin D deficiency masquerading as occult malignancy

ABSTRACT

At present, the diagnosis of a [brown tumor] is a clinical curiosity. It is considered to be a complication of severe and rapidly progressive hyperparathyroidism [HPT]. Indeed, such a presentation is typical of a patient harboring a parathyroid carcinoma. The incidence of brown tumors is 3% in the benign form of primary hyperparathyroidism [1]. In secondary HPT, the incidence of brown tumors is under 2% and is caused by chronic renal failure.[1] Brown tumors are locally destructive lesions consisting of fluid-filled cysts that are rich in highly vascularized fibrous tissue containing hemorrhagic spots. Blood pigment [hemosiderin] will accumulate, which imparts a reddish-brown hue and hence the name [brown tumor].[1] Brown tumors are demonstrated radiologically as lesions of osteitis fibrosa cystica [1]. We describe a young lady who was erroneously diagnosed elsewhere as a case of metastatic bone disease. Our evaluation documented this as a case of vitamin D deficiency [VDD] causing secondary hyperparathyroidism [SHPT] with diffuse distribution of brown tumors in her skeleton. Following vitamin D and calcium treatment, the patient improved