Osteitis Fibrosa Cystica: An Unusual Cause of Left-Sided Chest Pain

We report a case of osteitis fibrosa cystica resulting from secondary hyperparathyroidism in a 21-year-old male patient with end-stage renal disease. The patient presented with persistent, moderate chest pain localized to the left fifth and sixth ribs for eight months. A chest X-ray revealed well-defined, expansile lytic lesions in these ribs. Prior testing showed elevated parathyroid hormone (PTH) levels for five years, along with decreased serum calcium and elevated phosphorus levels. Findings from ultrasound and SPECT scans were consistent with hyperparathyroidism. Repeat laboratory tests showed a PTH level of 939.8 pg/mL (normal: 10-69 pg/mL), calcium level of 8.3 mg/dL (normal: 8.4-10.2 mg/dL), and phosphorus level of 5.1 mg/dL (normal: 2.5-5.0 mg/dL). The patient declined surgical intervention and was managed conservatively with calcium and vitamin D supplementation. Within 4 weeks, symptoms resolved and calcium and phosphorus levels normalized, although PTH levels remained elevated. Osteitis fibrosa cystica can be challenging to diagnose due to its rarity, especially in developed countries, and its nonspecific clinical presentation. This case highlights the importance of considering this diagnosis and outlines an approach to management in resource-limited settings.