Hypocalcemia and tetany caused by vitamin D deficiency in a child with intestinal lymphangiectasia.
Primary intestinal lymphangiectasia is a rare disease of children, which is characterized by chronic diarrhea and complicated with malnutrition, including fat-soluble vitamin deficiency. We report a girl aged 4 years and 8 months who was diagnosed with the disease by endoscopic duodenal biopsy at 8 months of age. She presented initially with chronic diarrhea at 4 months of age. Generalized edema with hypoalbuminemia frequently occurred despite regular albumin supplements. Multiple vitamins initially were not supplied regularly. Episodes of tetany caused by hypocalcemia developed 4 years after the diagnosis of intestinal lymphangiectasia. Imaging study (long-bone X-ray and dual-energy X-ray absorptiometry) revealed low bone density. Complicated vitamin D deficiency [low serum 25-hydroxy vitamin D concentration (< 12.48 mmol/L, the detection limit)] and secondary hyperparathyroidism were confirmed via blood testing. Vitamin D supplementation for 3 months improved her bone density, secondary hyperparathyroidism and frequent tetany. Vitamin D status should be monitored in patients with intestinal lymphangiectasia.
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Ying-Yi
YY
Lu
Jia-Feng
JF
Wu
Yen-Hsuan
YH
Ni
Steven Shinn-Forng
SS
Peng
Chia-Tung
CT
Shun
Mei-Hwei
MH
Chang
D015502:Absorptiometry, Photon / Q000009:adverse effects; D001706:Biopsy; D015519:Bone Density / Q000187:drug effects; D002675:Child, Preschool; D019587:Dietary Supplements; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications; D006996:Hypocalcemia / Q000209:etiology* / Q000503:physiopathology; D008201:Lymphangiectasis, Intestinal / Q000150:complications / Q000473:pathology*; D011504:Protein-Losing Enteropathies / Q000150:complications; D013746:Tetany / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage; D014808:Vitamin D Deficiency / Q000150:complications* / Q000628:therapy
D014807:Vitamin D