UNUSUAL AND MEMORABLE
Oncogenic hypophosphataemic osteomalacia mimicking bone metastases on isotope bone scan
Department of Rheumatology, Sandwell General Hospital, West Bromwich, UK
Correspondence to:
Correspondence to:
Dr F H Khattak
Department of Rheumatology, Sandwell General Hospital, West Bromwich B71 4HJ, UK; Fazal.Khattak@swbh.nhs.uk
Accepted 1 September 2006
| The first 150 words of the full text of this article appear below. |
A 61-year-old man presented with an 18-month history of musculoskeletal pain affecting the dorsolumbar spine, ribs and thighs, and a 6-month history of pain and swelling of the left foot. Examination showed rib tenderness, and mild swelling and tenderness of the left foot. The only abnormality detected on initial investigations was a raised alkaline phosphatase of level 266 U/l (normal range 37–170 U/l). Plain radiographs of the lumbar spine and foot were normal, but an isotope bone scan showed extensive hot spots in the left foot and in the ribs bilaterally, which were highly suggestive of metastases (fig 1
).
[in a new window] Figure 1 An isotope bone scan showing hot spots in the left foot and in the ribs, suggestive of metastases.
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An extensive search for malignancy was negative. Serum levels of 25 hydroxyvitamin D3 (25,OHD3), parathyroid hormone and calcium were normal, but serum phosphate was consistently low (0.5–0.7 mmol/l). Further, vitamin D3
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