Leontiasis ossea in the setting of chronic kidney disease and limited dialysis access: A case report with discussion of therapeutic implications

Leontiasis ossea, also known as craniofacial fibrous dysplasia, is a rare form of osseous hypertrophy of the facial bones associated with chronic kidney disease and secondary hyperparathyroidism. As the condition progresses, changes in bone structure can lead to severe facial disfigurement, respiratory difficulties, dysarthria, and dysphagia. We describe the case of an approximately 30-year-old male with a long-standing history of end-stage renal disease who experienced rapidly progressing facial swelling and underlying bone changes following a period of poor access to dialysis. Despite brief symptomatic improvement following parathyroidectomy, the patient's hyperparathyroidism ultimately persisted. Subsequent immunomodulator therapy again offered subjective improvements but was discontinued in the setting of adverse effects. We provide a brief overview of the pathophysiology of leontiasis ossea, review imaging findings pertinent to the case presentation, and discuss relevant implications in the diagnosis and management of this disease.