An unusual presentation of vitamin d deficiency-a case report

• Published in: Indian journal of clinical biochemistry 2022-05, Vol.33 (S1), p.S51
• Main Authors: Anitha, B, Manimekalai, S, Dheebalakshmi, N
• Format: Article
• Language: English
• Subjects: Alfacalcidol; Blood; Bones; Calcifediol; Density; Medical examination; Vitamin D; Vitamin D deficiency
• ISSN: 0970-1915

Nowadays, a common presenting complaint to a general physician, in middle age females are fatigue, headache and joint pain. Recent studies have attributed that Vitamin D deficiency leads to vague symptoms like easy fatiguability, headache, joint pain and pedal edema other than rickets and osteomalacia. A 30-year-old female presented with symptoms of easy fatiguability and joint pain for more than 6 months and pitting pedal edema for 1 month. Laboratory investigations like complete blood count, renal function test, thyroid profile, liver function test, electrolytes and urine complete were done and found to be normal. Causes of pedal edema like renal cause and hypoproteinaemia were ruled out. Considering her age further investigation like vitamin D levels was done, which showed low level of 9.9 ng/ml (< 20 deficiency). Patient was started on vitamin D 60 K IU weekly once for 8 weeks and showed reduction in pedal edema and improvement in symptoms within 3 weeks of treatment initiation. Vitamin D, hormone which is synthesized 90% in the epidermis. It is a fat-soluble vitamin, plays crucial functions in bone, mineral metabolism and calcium homeostasis. Low vitamin D level results in hypocalcaemia causing increase in parathormone level and skeletal demineralisation, decreased bone density, decrease in urinary calcium excretion and muscle weakness.. Studies have shown that increased concentrations of serum TNF-alpha, an inflammatory marker were found in women with vitamin D insufficiency and causes Bone marrow edema syndrome. In conclusion, Vitamin D deficiency is more common in middle aged females presenting with fatiguability and nonspecific pedal edema than expected.