Chronic Kidney Disease Presenting With Brown Tumors in the Mandible

A 45-year-old man with stage 4 chronic kidney disease (CKD) on controlled dialysis presented with right-sided painful jaw swelling and protruding into the oral cavity for one year. Examination revealed a 3 x 2.5-cm hard, fixed, and tender swelling of the right mandible. Imaging showed expansile radiolucent lesions in bilateral retromolar regions of the mandible, local destruction of the basal bone, and diffuse osteopenia of the skull. Laboratory investigations revealed elevated parathyroid hormone (PTH), elevated serum calcium, normal serum phosphorous, and elevated alkaline phosphatase (ALP). A provisional diagnosis of tertiary hyperparathyroidism (HPT) causing brown tumors was made, which was confirmed on histopathology. Surgical removal of the lesion and subtotal parathyroidectomy were done followed by cinacalcet and controlled dialysis. This case report highlights the possibility of encountering multiple focal brown tumors in a patient and the importance of their differentiation from malignancy.