Baylor University Medical Center Proceedings October 2017 - 465

Usefulness of nuclear whole-body bone scanning
for diagnosis of leprosy
Hector Marquez, MD, Joseph McDevitt, MD, Orhan K. Öz, MD, PhD, and Jason Wachsmann, MD

Leprosy, or Hansen's disease, is rare in
the United States. Given its rarity, as well
as the pathognomonic dermatologic
findings, there are few cases in which
nuclear medicine imaging plays a role
in the diagnostic workup. We present a
39-year-old man who presented with
chronic abdominal pain, skin ulcers,
and hypercalcemia who underwent
computed tomography of the chest
and a whole-body bone scan to evaluate for possible underlying neoplasm
due to his profound hypercalcemia.
Although the diagnosis of leprosy had
been established by lower-extremity
skin biopsy upon admission, workup
for other potential concurrent etiologies of hypercalcemia was performed
before initiating therapy. We present the
computed tomography scans, nuclear
medicine images, and corresponding
skin findings of this case.

Figure 1. (a) The patient's face and (b, c) lower-extremity nodules and ulcerations. (d, e) Transaxial images of diagnostic
chest computed tomography demonstrating pulmonary opacities (arrow).

eprosy, or Hansen's disease,
is rare, with <200 cases reported annually in the United
States (1). Hypercalcemia related to leprosy is uncommon and seen in only a small fraction of patients. In
leprosy it is likely caused by granulomatous tissue causing high
serum concentrations of 1,25-dihydroxyvitamin D (2). In contrast, hypercalcemia of malignancy is common, with a reported
incidence as high as 30% in patients with malignancies (3).
Multiple myeloma and lung and breast carcinoma have the
highest associations with this complication (4). Four major
mechanisms lead to hypercalcemia of malignancy: tumor production of calcitriol, osteolytic metastases, production of parathyroid hormone-related peptide by the tumor, and production
of parathyroid hormone by the tumor (5). The purpose of this
report is to demonstrate a rare disease and the role of nuclear
whole-body bone scanning in the diagnosis.

Proc (Bayl Univ Med Cent) 2017;30(4):465-466

CASE DESCRIPTION
A 39-year-old man presented to the emergency department
with several months of chronic abdominal pain and profoundly
elevated serum calcium (>14 mg/dL), along with nonhealing
ulcers (Figure 1b, 1c) and numbness in his legs. Chest computed
tomography was performed for evaluation of any possible underlying malignancy, which identiﬁed multiple lung opacities,
including a small cluster of nodules in the right upper lobe

From the Division of Nuclear Medicine and Molecular Imaging, Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
Corresponding author: Jason Wachsmann, MD, Department of Radiology,
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas,
TX 75390-8896 (e-mail: Jason.Wachsmann@UTSouthwestern.edu).

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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017