Atypical Presentation of Paget’s Disease of Bone: A Case Report

Paget’s disease of bone (PDB) is characterized by increased bone turnover and generally affects the skeleton extensively. The diagnosis is usually made with coincidentally detected high alkaline phosphatase (ALP) levels and/or suspicious x-rays during screening for other conditions. 10-15% of cases have normal ALP levels. A 72-year-old male subject was evaluated in the Neurosurgery Outpatient division with a symptom of low back pain. Lumbar magnetic resonance imaging (MRI) detected spondylolisthesis and a lytic lesion in the L4 vertebral body. Screening for possible malignancy revealed no primary tumor site. The serum ALP level was normal. He underwent surgery for probable malignancy and the pathology report revealed PDB. PDB is a benign condition which should be considered in the differential diagnosis of bone metastasis and should be kept in mind that patients can have normal ALP levels and examination of the pathology specimen may give the final diagnosis. Turk Jem 2012; 16: 99-101