A Rare Presentation of a Rare Disease - Primary Hyperparathyroidism Presenting as Polyarthritis - A Case Report

Primary hyperparathyroidism is due to inappropriate over secretion of parathyroid hormone by parathyroid glands. It is often diagnosed by routine biochemical screening. Advance disease can cause multiple complications involving renal, musculoskeletal, gastrointestinal and neuropsychiatric systems. Polyarthritis is a rare presentation of primary hyperparathyroidism. Chest pain and dyspnoea are two common symptoms of various pathological conditions found in respiratory units. Detailed analysis of clinical and investigation findings is utmost important to arrive at the proper diagnosis.We report a 45 year old female who had presented with arthritis involving multiple large and small joints for three years. She had been diagnosed as sero-negative rheumatoid arthritis and commenced on disease modifying anti-rheumatic drugs. She presented to us with non-specific chest pain and shortness of breath associated with poorly controlled joint pain and found to have severe hypercalcaemia with multiple lytic lesions and a pathological fracture. The diagnosis of rheumatoid arthritis was revised and excluded, and arthritis was recognized as the presenting feature of primary hyperparathyroidism following extensive evaluation. This case illustrates a rare presentation of a rare disease. The diagnosis of primary hyperparathyroidism is often delayed due to non-specific nature of symptoms in places without routine biochemical screening. Articular manifestations can occasionally be the presenting complains of patients with primary hyperparathyroidism. It may mimic many common conditions with arthritis. Hence, a thorough history combined with clinical examination is utmost important for physicians to arrive at proper diagnosis.

Author(s): Dushantha Madegedara, Asela Rasika Bandara, Rathnayake RMDHM and Samadara Nakandala

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