Xu Changyun, Ma Chao, Bai Yongli
Nuclear Medicine, Shaanxi Provincial People's Hospital, Affiliated to School of Medicine Xian Jiaotong University, Xian, Shaanxi, China.
Hell J Nucl Med. 2017 Jan-Apr;20(1):93-96. doi: 10.1967/s002449910515. Epub 2017 Mar 20.
We present a case of a 13 years old boy who was hospitalized with a 10 months history of progressive pain and weakness in his lower extremities. The laboratory tests revealed slightly decreased phosphate and 25-hydroxyvitamin D3, high alkaline phosphatase, normal calcium and parathyroid hormone (PTH). Magnetic resonance imaging (MRI) showed multiple patchy lesions indicating bone destruction in the metaphyses and epiphyses of the left knee. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) revealed a generalized decrease of bone density in axial bones with slightly increased F-FDG metabolism. Whole body technetium-99m methylene diphosphonate (Tc-MDP) scintigraphy revealed multiple areas of increased uptake at costochondral junctions of the ribs bilaterally suggesting a rachitic rosary and at the metaphyses of the bones of the limbs. Based on these findings we suggested the diagnosis of hypophosphatemic rickets (HPR). Phosphate and vitamin D substitution resulted in clinical improvement of the symptoms after 3 months.
我们报告一例13岁男孩，他因下肢进行性疼痛和无力10个月而住院。实验室检查显示磷酸盐和25-羟基维生素D3略有降低，碱性磷酸酶升高，钙和甲状旁腺激素（PTH）正常。磁共振成像（MRI）显示多个斑片状病变，提示左膝关节干骺端和骨骺骨质破坏。氟-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）显示轴向骨骼骨密度普遍降低，F-FDG代谢略有增加。全身锝-99m亚甲基二膦酸盐（Tc-MDP）闪烁显像显示双侧肋骨肋软骨交界处多处摄取增加，提示佝偻病串珠，四肢骨骼干骺端也有摄取增加。基于这些发现，我们诊断为低磷性佝偻病（HPR）。补充磷酸盐和维生素D 3个月后症状有临床改善。
