Uremic Leontiasis Ossea in a young patient with chronic kidney disease on dialysis: A rare case report

Introduction: Leontiasis ossia is a rare craniofacial manifestation characterized by diffuse expansion and remodeling of facial bones resulting in a "lion-like" (leonine) facies. It is most commonly associated with uremic renal osteodystrophy secondary to chronic kidney disease (CKD) and severe secondary hyperparathyroidism.

Case report: A 27-year-old patient with known CKD on maintenance dialysis presented for evaluation. 3D CT of the face demonstrated diffuse, symmetrical expansile osseous enlargement of the mandible and maxilla with a characteristic "tigroid" internal architecture.

Discussion: The symmetrical involvement and laminated trabecular reorganization are hallmark features of uremic leontiasis ossia. These findings, combined with diffuse calvaria permeative remodeling and diploic widening, help differentiate this metabolic condition from craniofacial fibrous dysplasia.

Conclusion: This case highlights the classic radiological features of uremic leontiasis ossia. Early recognition of these symmetrical craniofacial changes is essential for accurate diagnosis and optimal metabolic management in patients with renal osteodystrophy.