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Case history
A 32 years old female presented to our clinic in May 2012 complaining of generalized bony pain and inability to walk for the last 2 years (wheel chair bound ). 12 years ago she had thrombocytopenia which improved with steroid treatment & splenectomy. She has been receiving steroids for the last 12 years in the form of prednisone 60mg/d for 10 years which was decreased gradually to 10mg/d over the last 2 years.
Case examination
Loss of height Severe kyphosis Protuberant chest Tender fibromyalgia points Cushinoid features
Labs Revealed:
ESR : 32 mm/hr CRP : negative HB : 8.7 g/dl WBC: 14.2/cumm PLT : 100,000/cmm Creat: 0.8 mg/dl AST: 56 IU/L ALT: 74 IU/L S.alb: 3.4g/dl Alk phos : 382 IU/L TP : 8.8 g/dl Thyroid profile: normal 10/22/2012
ANA & DNA : negative Anti-platelet Ab: positive Hepatitis C: positive Total Ca: 8.6 mg/dL S.phosp: 2.1 mg/dl PTH : 129 pg/ml 25 (OH) vit D: 15 ng/ml =
37.5nmol/L
HH
<30
<12
3050
1220
50
20
>125
>50
Radiological findings
Chest x-ray :
deformity of the dosal spine Multiple wedge and compression fractures of dorsal and lumbar spine 1st degree spondylolithesis of L5 over S1 Spondylotic changes are found Surgical clips are seen at left hypochondrial region ( splenectomy)
coxa vena deformity Bones appear porotic Sub-chondral sclerotic areas are seen at the left femoral head ( ? Avascular necrosis)
DEXA
Site T-Score
Spine
6.3
Femur
5.5
Radius
6.5
14
Management :
Azathiaprine :
100mg/d Prednisone : 7.5mg/d Paracetamol
Parathormone inj/d Calcium 500mg /twice Vit D : 0.25 mcg / d Nasal calcitonin 200 IU/d
10/22/2012
HH
15
10/22/2012
HH
16
Thanks