Hypophosphatemic osteomalacia due to cadmium toxicity in silverware industry: A curious case of aches and pains

Autor: Ayan Roy, Taurja Saha, Jayaprakash Sahoo, Abanti Das
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Journal of Family Medicine and Primary Care, Vol 13, Iss 6, Pp 2516-2519 (2024)
Druh dokumentu: article
ISSN: 2249-4863
2278-7135
DOI: 10.4103/jfmpc.jfmpc_1836_23
Popis: Hypophosphatemic osteomalacia in an adult often gives clinical diagnostic challenges. Usually, they are caused by either tumor-induced osteomalacia or due to genetically mediated hypophosphatemia, particularly X-linked hypophosphatemia. However, heavy metal toxicity, leading to global proximal renal tubular dysfunction, is a rare cause, and in particular, cadmium toxicity is rarely encountered in clinical practice. The presence of bony pain and neurological deficit, along with a classical exposure history, provides the diagnostic clue. In this background, here we present a middle-aged man who had severe bony pains all over his body and lower back stiffness for five years. He underwent an initial workup as a suspected spondyloarthropathy but was later on, found to have hypophosphatemic osteomalacia and severe proximal renal tubular dysfunction. Further, the workup revealed elevated FGF-23. His occupational history revealed prolonged exposure to cadmium fumes in the silverware industry. He improved moderately with treatment; however, significant renal damage is still present. This case highlights the importance of considering cadmium toxicity in proper clinical and occupational contexts in the evaluation of hypophosphatemic osteomalacia in an adult.
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