Leontiasis Ossea Following Secondary Hyperparathyroidism and Hemodialysis

Abstract

Leontiasis ossea is a rare medical condition which is characterized by an overgrowth of the facial and cranial bones secondary to chronic renal failure and secondary hyperparathyroidism. We reported a case of leontiasis ossea with history of secondary hyperparathyroidism due to end-stage renal disease on regular hemodialysis. A 37-year-old female with end-stage renal disease from lupus disease on regular hemodialysis complaining of progressive facial deformity for two years causing dyspnea, dental malocclusion and dysarthria with the final diagnosis of uremic leontiasis ossea. It is important to recognize features of leontiasis ossea, as it may result in life-threatening upper airway obstruction and compressive cranial neuropathy while after parathyroidectomy, facial changes can be stabilized or improved mildly.

Uremic Leontiasis Ossea: A Rare Presentation of Chronic Renal Failure Secondary to Hyperparathyroidism

“…In addition to the cosmetic impairment, patients suffer functional impairment, including nerve compromise and potential airway obstruction. These clinical changes can be stabilized or improve mildly after parathyroidectomy [3]. In our case, the pathognomonic facial enlargement is secondary to hyperparathyroidism after long-standing CRF.…”

“…Uremic leontiasis ossea refers to the massive thickening of craniofacial bones as a result of CRF [3]. Its clinical presentation includes progressive painless massive enlargement of the jaws, widening of the nares, flattening of the nasal bridge, and increased interdental spacing.…”

“…Diagnosis of the specific osteodystrophy type is a rather complex process and various biochemical markers and radiographic findings are used so as to facilitate this stage [2]. Findings of RO caused by secondary hyperparathyroidism (SH) in cranial bones are frequent and include osteomalacia, osteosclerosis, and erosion of the cortical bone, brown tumors, and resorption of the lamina dura [3]. During the last decade this uremic complication is less frequently reported in the literature.…”

Uremic leontiasis ossea due to secondary hyperparathyroidism complicated by vitamin C deficiency in a non-adherent chronic hemodialysis patient: A case report

“…It may be present in the context of Paget’s disease, acromegaly, fibrous dysplasia or secondary HPT from ESKD (uremic leontiasis ossea). Uremic leontiasis ossea is a rarely reported manifestation of renal osteodystrophy [11, 12, 13, 14, 15, 16, 17, 18]. Histologically, it resembles fibrous dysplasia except for the presence of giant cells which suggest a reactive condition [19].…”

“…Radiographically, there is diffuse hypertrophy of the jaw bones, with ground-glass appearance and without the localized lytic masses typical of Brown tumors [20]. The bone enlargement can be severe enough to cause compressive neuropathies and even airway compromise [14, 15]. Treatment with parathyroidectomy only rarely leads to improvement in bone deformities [21, 22].…”