A rare case of asymptomatic Paget's disease of the skull in a 60-year-old Asian female.

Background and Aim: Paget's disease of the bone refers to a chronic cumulative disorder characterized by enhanced osteoclastic function followed by a secondary surge in osteoblastic activity. The condition can manifest as a polyostotic or monostotic bone disease with most patients having an asymptomatic presentation, although some may complain of pain localized to the affected bone while others express symptoms of nerve compression. A pagetic bone is predisposed to develop pathological fractures, bony deformities, and a rare yet detrimental transformation into osteosarcoma. Detection is often accidental when performing radiographic tests for other indications or when elevated blood levels of alkaline phosphatase (ALP) are detected. Treatment with third-generation bisphosphonates is helpful in preventing further bone resorption and, additionally, reduces bony pains that are believed to be caused by excessive metabolic activity. Here, we present a case of a middle-aged asymptomatic female with elevated serum ALP levels up to 1537 IU/L (reference range 40-150 U/L) during her pre-operative evaluation for elective cholecystectomy. Relevance for Patients: The rarity of this disease in Southeast-Asians, its uncontrived detection, and the isolated skull involvement, imparts high clinical relevance on this case. Early detection and management of this disease can help prevent the development of life-threatening complications in affected patients, hence decreasing the morbidity.