Middle aged woman presented with shins pain and conductive hearing loss

Paget’s disease is the second most common bone disorder, involving cellular remodeling and deformity of one or more bones. The estimated incidence of Paget’s disease is 2-3 people in 100 and increases in elderly (over 55), but often goes unnoticed because it may not cause any symptoms. Paget’s disease is unusual before 50 years of age. The most common manifestation is bone pain that may lead to deformities or fractures. Usually pelvis, skull, spine and legs are affected. If the disease process involves the temporal bone, a progressive loss of hearing may occur. Case report:Patient is a 45-year-old female who visited multiple physicians with a complaint of hearing loss and severe pain in the legs that started 6 months ago. Her hearing loss was conductive and unilateral and her pain was in the shins. As there was no definite diagnosis for her, she was referred to a rheumatologist. Her lab tests revealed ALP=1000 and Ca=10. Her X-rays revealed multiple osteoporotic and osteoplastic areas in both legs. Due to a rise in alkaline-phosphatase and calcium levels in her labs and her X-ray, she was diagnosed with Paget’s disease. She was treated with Bisphosphonate and therefore went into clinical remission.Discussion: Here we reported a case of middle-aged woman with atypical presentations of Paget’s disease. Paget’s disease is unusual before the age of 50 and hearing loss is a rare manifestation in this condition. So, a careful evaluation is necessary in order to putting a correct diagnosis when symptoms of the patient is unusual.