28353596 Visualization

A 47 Age - year Age - old Age female Sex patient presented Clinical_event progressively Detailed_description worsening Detailed_description pain Sign_symptom in the chest Biological_structure wall Biological_structure , back Biological_structure , and bilateral Biological_structure lower Biological_structure extremities Biological_structure as well as muscle Sign_symptom weakness Sign_symptom .
She did Family_history not Family_history have Family_history a Family_history family Family_history history Family_history of Family_history bone Family_history disease Family_history or Family_history fractures Family_history .
Physical Diagnostic_procedure examination Diagnostic_procedure was unremarkable Lab_value excluding Detailed_description bone Detailed_description and Detailed_description muscular Detailed_description abnormalities Detailed_description .
Bone Biological_structure scintigraphy Diagnostic_procedure using Detailed_description technetium-99m methylenediphosphate Detailed_description showed increased uptake Sign_symptom in the shoulder Biological_structure , multiple Biological_structure ribs Biological_structure , thoracic Biological_structure and Biological_structure lumbar Biological_structure spines Biological_structure , bilateral Biological_structure sacroiliac Biological_structure joints Biological_structure , left Biological_structure ilium Biological_structure , and left Biological_structure foot Biological_structure (Fig.1).
Plain Detailed_description radiographs Diagnostic_procedure revealed osteoporosis Disease_disorder change of thoracic Biological_structure and Biological_structure lumbar Biological_structure spine Biological_structure as well as compression Sign_symptom change of several Biological_structure spines Biological_structure , consistent with findings of magnetic Diagnostic_procedure resonance Diagnostic_procedure imaging Diagnostic_procedure and computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) (Fig.1).
Decreased Lab_value bone Diagnostic_procedure mass Diagnostic_procedure was presented in the lumbar Biological_structure spine Biological_structure ( T Lab_value - score: Lab_value −3.4), femoral Biological_structure neck Biological_structure ( T Lab_value - score: Lab_value −3.1), and hip Biological_structure ( T Lab_value - score: Lab_value −3.5).
Main laboratory data are shown in Table ​1.
She demonstrated hypophosphatemia Sign_symptom , hypokalemia Sign_symptom , hypouricemia Sign_symptom , elevated Lab_value level of ALP Diagnostic_procedure , C Diagnostic_procedure - telopeptides Diagnostic_procedure and chloride Diagnostic_procedure , and decreased Lab_value carbon Diagnostic_procedure dioxide Diagnostic_procedure combining Diagnostic_procedure power Diagnostic_procedure .
The urinalysis Diagnostic_procedure revealed a high Lab_value pH Diagnostic_procedure value, increased Lab_value level of potassium Diagnostic_procedure , and decreased Lab_value level of specific Diagnostic_procedure gravity Diagnostic_procedure , chlorine Diagnostic_procedure , and phosphate Diagnostic_procedure .
Persistent Detailed_description glycosuria Sign_symptom and proteinuria Sign_symptom were repeatedly found, despite normal Lab_value HbA1c Diagnostic_procedure and plasma Diagnostic_procedure glucose Diagnostic_procedure level.
Other laboratory Diagnostic_procedure test Diagnostic_procedure results including thyroid Diagnostic_procedure function Diagnostic_procedure test, serum Diagnostic_procedure parathyroid Diagnostic_procedure hormone Diagnostic_procedure , 25 Diagnostic_procedure - hydroxyvitamin Diagnostic_procedure D Diagnostic_procedure , and protein Diagnostic_procedure electrophoresis Diagnostic_procedure were within Lab_value normal Lab_value range Lab_value .
In addition, all of serum Diagnostic_procedure tumor Diagnostic_procedure markers Diagnostic_procedure were negative Lab_value .
Due to limited technique, we cannot determine the level of serum Diagnostic_procedure fibroblast Diagnostic_procedure growth Diagnostic_procedure factor Diagnostic_procedure 23 Diagnostic_procedure .
With the clinical diagnosis of HO Disease_disorder , fluorodeoxyglucose Diagnostic_procedure positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure / computed Diagnostic_procedure tomography Diagnostic_procedure ( 18F Diagnostic_procedure - FDG Diagnostic_procedure PET Diagnostic_procedure / CT Diagnostic_procedure ) and technetium-99m octreotide Detailed_description ( 99mTc Detailed_description - OCT Detailed_description ) scintigraphy Diagnostic_procedure were performed to confirm whether the occult Detailed_description causative Detailed_description tumor Sign_symptom exist.
However, the results of these Coreference 2 Coreference tests Coreference were negative Lab_value except that mild Severity uptake Sign_symptom in the seventh Biological_structure rib Biological_structure was found on PET Diagnostic_procedure / CT Diagnostic_procedure , which identified no evidence of a neoplastic Detailed_description lesion Sign_symptom potentially responsible for HO (Fig.2).
The immunological Diagnostic_procedure examination Diagnostic_procedure showed elevated Lab_value level of serum Diagnostic_procedure IgG Diagnostic_procedure , IgM Diagnostic_procedure , and IgA Diagnostic_procedure , as well as positive Lab_value antinuclear Diagnostic_procedure antibody Diagnostic_procedure , anti Diagnostic_procedure - SSA Diagnostic_procedure antibody Diagnostic_procedure , and rheumatic Diagnostic_procedure factor Diagnostic_procedure .
Subsequently, Schirmer Diagnostic_procedure test Diagnostic_procedure was abnormal Lab_value and lip Biological_structure biopsy Diagnostic_procedure supported the diagnosis of SS Disease_disorder (Fig.3).
Eventually, this patient was diagnosed with HO Disease_disorder secondary to SS Disease_disorder , and she was then treated with alkalinization Therapeutic_procedure ( citrate Medication 4 Dosage   g/day Dosage and potassium Medication citrate Medication 3 Dosage   g/day Dosage for 2 Duration weeks Duration ), steroids Medication ( prednisone Medication 20 Dosage   mg/day Dosage for 1 Duration month Duration , 10 Dosage   mg/day Dosage for 4 Duration months Duration ), neutral Medication phosphate Medication ( 1.0 Dosage   g/day Dosage for 5 Duration months Duration ), calcium Medication supplements Medication ( 600 Dosage   mg/day Dosage for 5 Duration months Duration ), and together with activated Medication vitamin Medication D Medication ( 0.5 Dosage   g/day Dosage for 5 Duration months Duration ).
So far, she recovered Sign_symptom uneventfully with relieved pain Sign_symptom and increased Lab_value serum Diagnostic_procedure phosphorus Diagnostic_procedure level.
This case report was approved by the ethics committee of West China Hospital of Sichuan University, Chengdu, China, and the written informed consent was obtained.