Proximal myopathy in lacto-vegetarian Asian patients responding to Vitamin D and calcium supplement therapy - two case reports and review of the literature

Hood Thabit,Diarmuid Smith,Maurice Barry,Seamus Sreenan

doi:10.1186/1752-1947-5-178

Hood Thabit, Diarmuid Smith + Show 2 more

Open Access

https://doi.org/10.1186/1752-1947-5-178

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Abstract

IntroductionSevere proximal myopathy can occasionally be the first presenting complaint of patients with osteomalacia. This may lead to investigations and misdiagnosis of a neuromuscular disease, rather than a metabolic bone disease.Case presentationsWe present here two cases of severe proximal myopathy in patients who were both of South Asian origin and lacto-vegetarians: a 31-year-old Indian man and a 34-year-old Indian woman. In both cases, their clinical symptoms fully resolved following vitamin D and calcium replacement therapy. These patients were at risk of osteomalacia due to their dietary intake and ethnicity. The role of dietary intake and sunlight exposure in the development of osteomalacia in certain ethnic groups living in Western Europe is reviewed here.ConclusionThese two cases emphasize the importance of recognizing osteomalacia in at-risk individuals, as the condition is reversible and easily treated with vitamin D and calcium supplementation. It may also help avoid prolonged and unnecessary investigations of these patients.

Highlights

Severe proximal myopathy can occasionally be the first presenting complaint of patients with osteomalacia
These two cases emphasize the importance of recognizing osteomalacia in at-risk individuals, as the condition is reversible and treated with vitamin D and calcium supplementation
It is important in patients known to be at risk of vitamin D deficiency to consider a diagnosis of osteomalacia, as it is treatable and reversible

Summary

Conclusion

These two case reports highlight the importance of considering vitamin D deficiency in patients presenting with proximal myopathy, especially in those known to belong to high risk groups. A correct diagnosis can help avoid prolonged and needless investigations for these patients, as the condition is reversible and treated with vitamin D and calcium supplementation

Introduction

Discussion

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