Brown tumors revealed by SPECT/CT in a dialysis patient presenting with progressive neuropathic lower limb pain

Background

Brown tumors are benign osteolytic lesions caused by excessive bone resorption in severe and prolonged hyperparathyroidism. Although uncommon in patients undergoing dialysis, they should be considered in cases of severe refractory hyperparathyroidism and unexplained focal pain. Whole-body bone scintigraphy combined with single-photon emission computed tomography/computed tomography (SPECT/CT) may be particularly useful for detecting and localizing multifocal skeletal involvement. Case Presentation: We report the case of a 46-year-old man with end-stage kidney disease on hemodialysis and severe refractory hyperparathyroidism who presented with progressive neuropathic pain in the right lower limb. Whole-body bone scintigraphy showed multiple areas of increased tracer uptake involving both tibias and distal femurs. SPECT/CT localized these abnormalities to bilateral intramedullary tibial lesions, consistent with multifocal brown tumors. The right tibial lesion corresponded to the symptomatic site. Revision parathyroidectomy was subsequently performed, resulting in rapid and marked symptomatic improvement.