Paget's disease of the pelvis

ABSTRACT

Paget's disease, also known as osteitis deformans, is characterized by rapid bone remodeling and the formation of bone that is structurally abnormal. Men are affected twice as often as women. The disease is uncommon in persons of African and Asian descent. The majority of patients with Paget's disease are usually asymptomatic, although the most frequent symptom is pain. This paper aims to present a rare case of Paget's disease in a local setting and to present the scintigraphic features of Paget's disease in correlation with other diagnostic modalities. This is a case of a 69-year-old female with a history of low back pain and difficulty in walking of one month duration. CT scan showed sclerotic changes in the right pelvic bone probably degenerative or infectious in nature, however, neoplastic process is not totally ruled out. Bone scan showed an osteoblastic lesion in the right hemipelvis. Considerations include Paget's disease and metastasis (in the presence of a primary neoplastic lesion). The alkaline phosphatase was elevated. An open bone biopsy of the right pelvis was done. Histopathologic report showed prominent cement lines with numerous large osteoclasts. This was signed-out as Paget's disease of the bone. Paget's disease is rare in the Philippines. Our case illustrated a common clinical feature of the disease seen in an elderly patient presenting with bone pain, elevated alkaline phosphatase value, and associated with cortical thickening and sclerosis of the right pelvis on radiolograph and osteoblastic lesion on bone scan.