Patient with end-stage renal disease due to dysplastic kidneys, renal osteodystrophy and tertiary hyperparathyroidism presented to the ER with acute-onset right abdominal pain. Lab tests were unremarkable. CT showed many lytic lesions consistent with brown tumors, several of which compressed the spinal cord, most severely especially at the T9 level.

Tumor markers were all negative. Pathology report of a vertebral biopsy came back as "compatible with brown tumor".

Neurological exam was partly abnormal, with a positive Babinsky test.

The patient underwent spinal decompression and fixation and subtotal parathyroidectomy (3 out of 4 glands).