Abstract
Background: Secondary hyperparathyroidism can present for the first time as myopathy in some patients. Strict vegans are at risk of vitamin D deficiency resulting in secondary hyperparathyroidism. A myopathic presentation may lead to investigations and misdiagnosis of neuromuscular disease, ratherthan a metabolic bone disease.
 Methods: We report a young lady presenting with severe progressive limb girdle pattern myopathy, with brisk reflexes and periphral neuropathy. Electrophysiology confirmed the presence of ,yopathy and neuropathy, and labaotorial evaluation revealed vitamin D deficiency and elevated parathormone levels.
 Results: She was supplemented with vitamin D, and on follow up was found to have a near complete improvement.
 Conclusion: Hence it is imperative to evaluate for vitamin D deficiency in all
 susceptible patients, especially with a history of strict vegetarianism.
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