Early-Onset Craniofacial Brown Tumor Progressing to Multifocal Skeletal Lesions in Peritoneal Dialysis Patient: A Case Report and Literature Review

Background: Brown tumors (BTs) are rare skeletal manifestations of osteitis fibrosa cystica caused by prolonged hyperparathyroidism. They are most commonly reported in patients with advanced secondary hyperparathyroidism undergoing hemodialysis. Conversely, early presentation in peritoneal dialysis (PD) remains uncommon, and craniofacial involvement is especially rare.Case Presentation: We report a case of a 27-year-old woman with end-stage renal disease on PD who developed a craniofacial BT shortly after dialysis initiation. A biochemical evaluation revealed markedly elevated parathyroid hormone (PTH) levels (3032 pg/mL). Despite initial partial regression, the BT rapidly progressed to multifocal skeletal lesions, including on the clavicle, humeral head, ribs, and ischiopubic ramus, associated with fractures and tumoral calcinosis. Medical management was initiated, and parathyroidectomy was planned.Conclusion: This case emphasizes the potential for early craniofacial BT development and rapid multifocal skeletal progression in PD patients with uncontrolled hyperparathyroidism. It further demonstrates that early detection and prompt surgical referral may be vital in preventing severe skeletal complications in PD patients with uncontrolled hyperparathyroidism.