Multiple spinal brown tumors presenting as compressive thoracic myelopathy in a patient on maintenance hemodialysis

Brown tumor, also known as osteitis fibrosa cystica, is a benign bone lesion due to excessive lytic action by osteoclasts, in the presence of primary, secondary, or tertiary hyperparathyroidism. Due to early screening, they are a rare occurrence. This report presents a case of a 47-year-old man on regular hemodialysis presenting with compressive thoracic myelopathy. Based on elevated parathyroid hormone, imaging, and histopathology, the diagnosis of brown tumor was confirmed. He then underwent tumor excision, following which the underlying secondary hyperparathyroidism was treated with calcitriol and calcium replacement. Though secondary hyperparathyroidism is a common complication of chronic kidney disease, brown tumors are a rare manifestation and uncommonly located in the spine. Differential diagnoses include metastatic lesions, plasmacytomas, giant cell granulomas, or simple bone cysts. Early diagnosis and management of a spinal brown tumor can prevent neurological complications.