Tertiary hyperparathyroidism with multiple Brown tumors mimicking malignancy

Brown tumors are an uncommon type of benign osteolytic bone lesions that occur in hyperparathyroidism, which is an endocrine disease characterized by excessive secretion of the hormone parathormone. They occur more in primary hyperparathyroidism and are seen to regress after removal of parathyroid adenomas. In our report, we describe a a case of tertiary hyperparathyroidism with multiple lytic lesions of the right great toe, left fibula, twelfth posterior rib on right side and base of middle phalanx of left hand. This report illustrates the importance of taking brown tumor in differential diagnosis in patients with multiple lytic lesions, occurring in the backdrop of chronic kidney disease, where a failure to establish an accurate diagnosis may lead to further unnecessary and painful diagnostic procedures and even extensive surgery.