title: Hypovitaminosis D presenting as diffuse myalgia in a 22-year-old woman: a case report.
abstract: BACKGROUND
  Caused predominantly by insufficient conversion of vitamin D precursors by sunlight, hypovitaminosis D is an issue of increasing importance worldwide. Although it has been associated with a range of diseases, musculoskeletal effects dominate the clinical picture and can lead to significant physical debility, whether acute or chronic. Although diagnosis of vitamin D deficiency typically occurs in the outpatient setting, it is an easily treatable condition, and timely intervention can dramatically improve one's quality of life. As highlighted by this case report, hypovitaminosis D may be an important but underappreciated etiology of undifferentiated myalgia that, when present, warrants initiation of vitamin D repletion therapy even from the emergency department (ED).
  
  
  METHODS
  A 22-year-old African-American female presented to our ED with diffuse myalgia for 4 months. She reported significant debility from these symptoms with difficulty ambulating and performing activities of daily living. There had been no upper respiratory infection symptoms. The patient had discussed all of this with her primary care physician who, despite an extensive laboratory work-up, had not identified a definitive etiology. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Chronic pain has stricken the ED patient population across the board. Studies demonstrate that the myalgia caused by hypovitaminosis D can have a profound and negative impact on an individual's lifestyle. Our patient was found to have hypovitaminosis D and had substantial improvement with her myalgia and quality of life after treatment. The purpose of this report is to help the emergency physician appreciate this disease and consider it when clinically appropriate.
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Deshon
authors.initials: D
authors.lastname: Moore
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Robert
authors.initials: R
authors.lastname: Wahl
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan; The Cardiovascular Research Institute, Wayne State University, Detroit, Michigan.
authors.forename: Phillip
authors.initials: P
authors.lastname: Levy
mesh_terms: D059350:Chronic Pain / Q000209:etiology; D005260:Female; D006801:Humans; D063806:Myalgia / Q000209:etiology*; D011788:Quality of Life; D014807:Vitamin D / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014815:Vitamins / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014815:Vitamins; D014807:Vitamin D
keywords: chronic pain; hypovitaminosis D; myalgia; vitamin D deficiency