Hypercalcemia with extraosseous MDP uptake in a bone scan as initial presentation in a case of cutaneous T-cell lymphoma

A middle-aged lady presented with headache, vomiting of sudden-onset with intermittent evening rise of temperature. She also had slurring of speech with no loss of consciousness or altered sensorium. The patient was under evaluation for hypercalcemia. A whole body bone scan was done to look for causes of hypercalcemia and the scan showed extraosseous ^99m Tc MDP (Technetium Methylene Di Phosphonate) uptake. One of the causes of extraosseous MDP uptake is cutaneous T-cell lymphoma (CTCL). On close interrogation the patient gave a history of hypopigmented dermal patches for more than 2 years duration. The coexisting dermal patches raised suspicion of CTCL. Skin biopsy confirmed CTCL. The patient was referred to oncology and was planned for six cycles of chemotherapy.

Keywords
Bone scan, cutaneous T-cell lymphoma, extraosseous MDP uptake, mycosis fungoides