We report a case of a 69-year-old woman with primary hyperoxaluria type I, who developed a severe hypercalcemia despite controlled secondary hyperparathyroidism. Bone scintigraphy showed diffuse increased uptake in axial and peripheral skeleton. 18F-FDG PET/CT showed countless striking hypermetabolic foci, interesting 2 types of lesions (joint calcifications and periosteal resorptions). Bone biopsy demonstrated inflammatory changes around many calcium oxalate crystals; hypercalcemia was then related to oxalate osteopathy. Immunotherapy with denosumab was thus initiated. Eighteen months later, a second PET/CT showed decreased 18F-FDG uptake, reflecting treatment efficacy on inflammatory reaction secondary to calcium oxalosis skeletal deposits.
From the *Service de Biophysique et de Médecine Nucléaire, Hôpitaux Universitaires de Strasbourg;
†ICube, Université de Strasbourg/CNRS UMR 7357; and
‡Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine, Strasbourg, France.
Received for publication June 12, 2018; revision accepted October 9, 2018.
Conflicts of interest and sources of funding: none declared.
Correspondence to: Céline Heimburger, MD, Service de Biophysique et de Médecine Nucléaire, Hôpital de Hautepierre, 1, Ave Molière, 67200 Strasbourg Cedex, France. E-mail: firstname.lastname@example.org.