Dr. David Hirschfeld, Junior Assistant Resident in Medicine, Jewish Hospital of St. Louis; and Assistant in Medicine, Washington University School of Medicine: A 62-year-old white woman was referred to this hospital in October 1968 for evaluation of Paget's disease, which was initially diagnosed by x-ray film in 1961 during intravenous pyelographic studies. The patient remained asymptomatic until 1963 when pain in the left side of the pelvis and left upper leg was noted. These symptoms have persisted with variable intensity to the present time. In 1967 the patient was subsequently seen at another institution and on two occasions received intravenously administered radioactive phosphorus therapy (sodium phosphate P32) for the complaints. In each instance, the administration of the isotope was apparently associated with symptomatic improvement of the bone pain. The patient denied any history of bone fracture or renal calculi.
Physical examination revealed a middle-aged woman in no acute distress. Pulse