[Multiple pathological fractures within the scope of DeToni-Debre-Fanconi syndrome after fumarate therapy in psoriasis].
We report about a rare case of a pathological fracture of the shank following earlier pathological fractures at other locations in a comparatively young female patient with no history of trauma. There were no known diseases other than psoriasis. The shank fracture was treated surgically by osteosynthesis. Osteoporosis, myeloma, or malignancy as causative factors of this fracture could be excluded. Scintigraphy showed an enhancement, especially at the extremities. Other than reactive bone growth, histological examination revealed no further aspects. Laboratory analysis indicated a massive lack of vitamin D3. After transferring the patient to the internal department of our hospital, long-term medication with fumaric acid was determined to be the reason for the osteomalacia of a Fanconi's syndrome. Three months after cessation of these medicaments and treatment with active vitamin D3 metabolites, the patient was free of complaints. The radiographs showed an essential improvement of the demineralization.
Warzecha
J
J
Frankfurter Diakonie-Kliniken Markus-Krankenhaus, Lehrkrankenhaus der Johann Wolfgang Goethe-Universität, Klinik für Unfallchirurgie, Wilhelm-Epstein-Strasse 2, 60431 Frankfurt a.M. joerg.warzecha@debitel.net
Runck
A
A
Priepke
E
E
Storm
H
H
Weigand
H
H
D000328:Adult; D016512:Ankle Injuries / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005265:Femoral Neck Fractures / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal; D005598:Fractures, Spontaneous / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D005650:Fumarates / Q000009:adverse effects*; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy*; D011859:Radiography; D012086:Reoperation; D013978:Tibial Fractures / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery
D005650:Fumarates; C032005:fumaric acid