technetium-tc-99m-medronate and Lupus-Erythematosus--Systemic

We report a case of a 39-year-old female with active systemic lupus erythematosus who complained of lethargy and weakness with a moderate renal impairment. Hypercalcemia was confirmed by laboratory examination. Her X-ray revealed significant ectopic calcinosis in subcutaneous tissue of bilateral hands, and Tc-99(m) methylene diphosphonate bone scan revealed a remarkably intense uptake of bilateral lungs. She had no evidence suggestive of other diseases related to hypercalcemia such as hyperparathyroidism and malignancy. She had abnormally high serum parathyroid hormone-related protein (PTHrP) which fell to normal after treatment. Glucocorticoid, cyclophosphamide plus calcitonin and etidronate were administered and the patient improved greatly. Literature review demonstrated that lupus-related hypercalcemia with ectopic calcinosis is a rare complication and increased PTHrP is probably one of the main mechanisms. Lung uptake in bone scan may be a special and reliable clue suggestive of hypercalcemia.

Topics: Adult; Biomarkers; Bone Density Conservation Agents; Calcinosis; Calcitonin; Cyclophosphamide; Drug Therapy, Combination; Etidronic Acid; Female; Glucocorticoids; Humans; Hypercalcemia; Immunosuppressive Agents; Lung; Lupus Erythematosus, Systemic; Parathyroid Hormone; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome; Whole Body Imaging

Topics: Adult; Female; Humans; Lupus Erythematosus, Systemic; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate; Vascular Diseases

The presented case is a 36-year-old woman with a history of systemic lupus erythematosus for 10 years. She had progressively painful swelling of the right index finger that later proved to be a rare case of tenosynovitis caused by Mycobacterium avium complex. Serial images of 3-phase bone scans, gallium scan, and magnetic resonance imaging demonstrate the area of involvement.

Topics: Adult; Citrates; Female; Fingers; Gallium; Gallium Radioisotopes; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Mycobacterium avium-intracellulare Infection; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tenosynovitis

Topics: Adrenal Cortex Hormones; Adult; Anemia, Hemolytic; Female; Femur Head Necrosis; Humans; Humerus; Knee Joint; Lupus Erythematosus, Systemic; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Shoulder Joint; Technetium Tc 99m Medronate

Sacroiliac joint radiographs and radionuclide sacroiliac joint uptake ratios were obtained on 14 patients with active systemic lupus erythematosus. Elevated joint ratios were found unilaterally in two patients and bilaterally in seven patients when their lupus was active. In patients whose disease became quiescent, the uptake ratios returned to normal. Two patients had persistently elevated ratios with continued clinical and laboratory evidence of active lupus. Mild sacroiliac joint sclerosis and erosions were detected on pelvic radiographs in these same two patients. There was no association between low back pain or HLA-B27 positivity and the radiographic or scintigraphic abnormalities. Elevated quantitative sacroiliac joint uptake ratios may occur as a manifestation of active systemic lupus erythematosus.

Topics: Adult; Diphosphonates; Female; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Radiography; Radionuclide Imaging; Sacroiliac Joint; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Amphotericin B; Anemia, Sickle Cell; Bone and Bones; Diphosphonates; Female; Humans; Hypercalcemia; Kidney; Lupus Erythematosus, Systemic; Male; Middle Aged; Nephritis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate