ARTHRITIS, HYPERCALCEMIA, AND LYTIC BONE-LESIONS AFTER HEPATITIS-B VACCINATION

We report a case of arthritis, hypercalcemia, and lyric bone lesions t hat occurred shortly after repeat ed administration of recombinant hep atitis B virus (HBV) vaccine in a 44-year-old man who had had myasthen ia gravis 20 years earlier, He presented with ankle and knee arthritis and hypercalcemia. Radiographs revealed small lyric lesions and densi tometry showed severe osteopenia. Quantimetric bone biopsy confirmed m ajor bone loss and showed dramatic increase in bone turnover, as well as an unusual periosteal apposition of woven bone. Short term treatmen t with prednisone and furosemide and longterm treatment with clodronat e allowed rapid improvement. After one year, the patient remains clini cally asymptomatic. Despite negative immunologic investigations to sus tain the hypothesis of HBV vaccination as a causal factor, we believe the bone lesions could be attributed to unusual bone ''hyperremodeling '' triggered by an immune process in a predisposed individual.