Rheumatoid arthritis demonstrated on PET/CT as the etiology of hypercalcemia.
نویسندگان
چکیده
mediciNe & HealtH/RHode islaNd a 60 year-old woman with a history oF breast cancer status-post lumpectomy in 1997, hypothyroidism, rheumatoid arthritis, irritable bowel syndrome, and chronic fatigue syndrome was admitted to the hospital for hypercalcemia. At the time of admission serum chemistries were significant for elevated serum calcium of 11.1 mg/dL, decreased albumin of 2.5 g/dL, suppressed parathyroid hormone (PTH) of 6 pg/mL, elevated angiotensin converting enzyme (ACE) of 93 U/L, and elevated C reactive protein (CRP) of 13.4 mg/L. The patient was discharged after one day and referred to endocrinology. A Technetium-99m-methylene diphosphonate bone scan was obtained to assess for metastatic disease as an etiology of hypercalcemia and was remarkable only for left sided rib fractures without evidence of osseous metastatic disease (Figure 1). A chest CT was performed to assess for sarcoidosis, given the elevated serum ACE level, but did not show pulmonary parenchymal changes or adenopathy to confirm this diagnosis. A positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose was then performed to assess for underlying malignancy (either breast cancer metastasis or another primary malignancy) or extrapulmonary sarcoidosis as the etiology of the patient’s hypercalcemia. Maximum intensity projection (MIP) image (Figure 2), as well as axial and coronal images (Figure 3) from the PET/CT scan showed increased activity at the atlantoaxial joint and symmetric markedly increased activity in the shoulders, scapulae, first costochondral joints, hips and ischia which were consistent with inflammatory changes from active rheumatoid arthritis. No additional abnormalities were seen on the PET/CT scan to indicate malignancy or sarcoidosis.
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ورودعنوان ژورنال:
- Medicine and health, Rhode Island
دوره 95 2 شماره
صفحات -
تاریخ انتشار 2012