Leontiasis ossea; a rare presentation of secondary hyperparathyroidism

Leontiasis ossea is a rare presentation of renal osteodystrophy with few reports in literature. it causes severe skeletal deformity in the cranial bones. this study presents a report on a patient with advanced hyperparathyroidism with skeletal changes compatible with leontiasis ossea. the patient was a 34-year-old man with end-stage renal disease, uncontrolled hypertension, and dyspnea who was referred to our hospital. physical examinations revealed: toggled speech (nasal speech), mouth breathing and facial change, saddle nose, nares widening, increased interdental space and mandibular enlargement. his serum intact parathyroid hormone (ipth) level was 3199 pg/ml, paranasal sinuses ct scan showed a significant expansion of the mandibular, maxillary and skull bones. parathyroid sonography reported two severe hypertrophied parathyroid glands. the patient underwent total parathyroidectomy as a result of symptomatic bone involvement.