Case 21

Clinical History:

A 58 year-old female with a long history of non-insulin dependent diabetes mellitus, essential hypertension and chronic renal failure presented with a several week long course of progressive bilateral ankle, foot, elbow and rib pain. She had no history of trauma, or of swelling or redness of the affected joints. She has a past history of gout, congestive heart failure, subendocardial myocardial infarction and anemia. Her medications include digoxin, lasix, Aldomet, Colchicine, Allopurinol, Amphagel, Kayexalate and folic acid.

The patient was afebrile and in no acute distress. Her feet, ankles, and elbows had normal ranges of motion with no point tenderness, crepitus, swelling or erythema. Her lower extremities had normal pulses, intact skin and no edema. She had stable mild cardiomegaly and retinopathy. Radiographs of the feet showed osteopenia, but no other signs or hyperparathyroidism fracture.

Chemistries were:

			2/82		5/83		6/84		2/85

Ca++			9.2		-----		9.3		9.1
(9.1-10.9 mg/dl)

PO4			4.9		-----		4.1		4.4
(2.3-4.3 mg/dl)

Alk Phosphatase	98		271		328		633
(16-95 IU/I)

Creatinine		3.6		5.0		5.2		6.9
(< 1.2 mg/dl)

Images

Desciption of findings

Full Case Report

________________________________________________________

J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu