Fever as the First Clue: an Atypical Case of Occult Brown Tumor
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A 46-year-old asian male presented with throat pain, hoarseness, dry cough and persistent high-grade fever unresponsive to antibiotics. Imaging showed left upper lobe consolidation and bronchoscopy revealed no infectious cause. Although the patient initially improved with intravenous antibiotics, fever recurred post-discharge, prompting further evaluation. Imaging identified multiple lytic bone lesions, initially suggestive of malignancy. However, bone biopsy revealed osteitis fibrosa cystica (Brown tumor), indicating metabolic bone disease. Laboratory tests showed markedly elevated parathyroid hormone (PTH) levels with high-normal serum calcium, confirming primary hyperparathyroidism. PET-CT and parathyroid scintigraphy localized a left inferior parathyroid adenoma. Surgical resection of the adenoma led to normalization of PTH levels and resolution of systemic symptoms, including fever. This case highlights fever as an atypical presentation of primary hyperparathyroidism and underscores the importance of considering endocrine disorders in cases of pyrexia of unknown origin, especially when conventional infectious and malignant causes are excluded.
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