Acute myelopathy in the inmediate postpartum secondary to Paget´s disease: case report

Lisbel   Garzón Cutiño; Deborah   Cabrera Rodríguez; Lázaro Antonio  Torres Campo; Ahmed  Rubier Ortega; Maytee  Olivera Vega

doi:10.59471/ijhsc2025241

Authors

Lisbel Garzón Cutiño Hospital Clínico Quirúrgico Docente “Dr. Miguel Enríquez”. Servicio de Neurología. La Habana. Cuba Author https://orcid.org/0000-0003-0991-6376
Deborah Cabrera Rodríguez Universidad de Ciencias Médicas, Facultad de Ciencias Médicas “Miguel Enríquez”. La Habana. Cuba Author https://orcid.org/0009-0002-1156-0225
Lázaro Antonio Torres Campo Universidad de Ciencias Médicas, Facultad de Ciencias Médicas “Miguel Enríquez”. La Habana. Cuba Author https://orcid.org/0000-0002-9360-1221
Ahmed Rubier Ortega Hospital Clínico Quirúrgico Docente “Dr. Miguel Enríquez”. Servicio de Neurocirugía. La Habana. Cuba Author https://orcid.org/0000-0003-4687-5681
Maytee Olivera Vega Hospital Clínico Quirúrgico Docente “Dr. Miguel Enríquez”. Servicio de Neurología. La Habana. Cuba Author https://orcid.org/0009-0007-2066-177X

DOI:

https://doi.org/10.59471/ijhsc2025241

Keywords:

Paget's disease, myelopathy, postpartum

Abstract

Introduction: Paget's disease, also known as osteitis deformans, is a chronic bone disorder characterized by abnormal bone remodeling. This process results in disorganized growth of bone tissue, affecting the architecture and functionality of the skeleton.
Case report: A 40-year-old female patient with a personal pathological history of arterial hypertension, postpartum due to physiological birth of 9 days of evolution. Since her birth she began to experience “tingling in her legs”, which progressively became duller until it was impossible for her to walk. The physical examination revealed: flaccid paraplegia, patellar hyporeflexia in both lower limbs, bilateral Babinski. The complementary examinations were within normal parameters except for immunoglobulin dosage, where a slight increase of IgG, KAPPA was observed. It was decided to perform magnetic resonance. Subsequently, she was evaluated by the Neurosurgery Service and underwent surgery to perform laminectomy plus flavinectomy of T6 and T7. The sample obtained is sent for study to the Pathological Anatomy Service, which reports marked fibrosis and hyalinization replacing bone tissue, concluding with Paget's Disease.
Conclusions: Myelopathy secondary to Paget's disease, such as that presented by the patient, as such is rare and may occur due to vascular steal rather than compression

References

Wei Z, Li S, Tao X, Zhu G, Sun Z, Wei Z, et al. Mutations in Profilin 1 Cause Early-Onset Paget's Disease of Bone With Giant Cell Tumors. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research. 2021;36(6):1088-103. https://doi.org/10.1002/jbmr.4275

Feki A, Sellami I, Gassara Z, Djemaa SB, Ezzeddine M, Kallel MH, Fourati H, Akrout R, Baklouti S. Spinal Paget´s disease with bilevel cord compression and ischemic non-compressive myelopathy treated with zoledronic acid. Wiley, Clinical Case reports. 2022; 10:e06263. https://doi.org/10.1002/ccr3.6263

Lombardi AF, Aihara AY, Fernandes A, Cardoso FN. Imaging of Paget's Disease of Bone. Radiologic clinics of North America. 2022;60(4):561-73. https://doi.org/10.1016/jrcl.2022.02.005

Gómez LD, Restrepo AA, Saldarriaga LM, Hermida C, Bernal AE. Enfermedad de Paget del hueso, reporte de dos casos clínicos en Colombia. Revista Cubana de Reumatología. 2024; 26:e1219. https://revreumatologia.sld.cu/index.php/reumatologia/article/view/1219

Tuck S, Layfield R, Walker J, Mekkayil B, Francis RJR. Adult Paget’s disease of bone: a review. Rehumatology. 2017;56(12):2050-9. https://doi.org/10.1093/rheumatology/kew430

Sarli M, Collaceli MD, Jerkovich F, Rey P, Spivacow R, Zanchetta MB. Clinical features,diagnostic evaluation and responses to treatment in Paget's disease ofbone in a center specialized in bone metabolism. Medicina. 2022;82(3):408-14. https://pubmed.ncbi.nlm.nih.gov/35639062

Miao XY, Wang XL, Lyu ZH, Ba JM, Pei Y, Dou JT, et al. Paget's disease of bone: Report of 11 cases. World journal of clinical cases. 2021;9(14):3478-86. https://doi.org/10.12998/wjcc.v9.i14.3478

Ospina AI, Gómez VE, Coy VA, Segur JS, Izquierdo JH. Enfermedad de Paget de hueso esporádica. Serie de casos y revisión de la literatura. Revista Colombiana de Reumatología. 2020; 27(2):103-111. https://doi.org/10.1016/j.rcreu.2019.07.004

Larroudé MS, Moggia MS, Man Z. Compromiso vertebral en la Enfermedad de Paget. Revista Argentina de Reumatología. 2009; 20(1). https://revistasar.org.ar/revistas/volumen-20-numero-1_7

Pallauta K, Palma P, Escobar P, Areny R. Enfermedad de Paget Ósea. Breve Revisión de la Literatura a Propósito de un Caso. Revista Chilena de Reumatología. 2017; 33(2): 49-57. https://sochire.cl/wp-content/uploads/2021/09/r-805-1-1507069791.pdf.