Atypical presentation of Paget's disease with secondary osteomyelitis of mandible

Abstract

Paget's disease (PD) is a chronic progressive disease of the bone characterized by abnormal bone resorption and deposition affecting either single bone (monostotic) or many bones (polyostotic). The precise etiology of the disease is unknown but it is likely that the disease is a result of a viral infection of the osteoclasts in a genetically susceptible host. It is inherited as an autosomal dominant trait with high penetrance. The patients affected are usually over forty years of age, and disease is often asymptomatic. The diagnosis is mainly based on biochemical markers of bone turnover and radiological examinations. Normal levels of calcium phosphates and markedly elevated serum alkaline phosphatase (SAP) is a constant feature of this disease. It is regarded as uncommon in Asians, Scandinavians, and black Africans. In India, Paget's disease is rare. Here, we report a rare case of PD with secondary osteomyelitis of mandible with biochemical, radiological, and dual X-ray absortiometry findings. The patient is currently undergoing treatment successfully using bisphosphonates (Alendronate), an anti-resorptive drug to decrease the morbidity associated with the disease.

Keywords

• Alendronate
• bisphosphonates
• cotton wool appearance
• osteitis deformans
• serum alkaline phosphatase