Vitamin D deficiency presenting like hypophosphatemic osteomalacia
A 41-year-old male presented with gradually progressive quadriparesis for past 6 months. Patient had low phosphorous (1.9 mg/dl) with calcium being 8.1 mg/dl and 25(OH)Vitamin D3 levels being 8.12 ng/ml. The patient was thought to have concomitant vitamin D deficiency with possibility of tumor-induced osteomalacia. Further evaluation for the same was planned. However, the patient was given a trial of vitamin D supplementation before further investigations were done and he had dramatic improvement in the muscle power, which improved gradually over next 6 weeks and he was able to climb stairs after 2 months. Retrospectively patient gave a history of being at home for many months and there was no exposure to sunlight at all. The calcium and phosphorus levels normalized within 4 weeks of starting vitamin D supplementation and serum alkaline phosphatase showed drastic reduction after 6 weeks. All his family members were screened and found to have vitamin D deficiency including twins aged 1 year who had rachitic changes.