title: Vitamin D-deficient osteomalacia due to excessive self-restrictions for atopic dermatitis.
abstract: A 34-year-old Japanese woman presented with a 2-year history of generalised bone pain, muscle weakness and gait disturbance. The patient had been following a restricted diet (without fish or dairy products) and avoiding ultraviolet exposure for 8 years to manage her worsening atopic dermatitis. Physical examination revealed generalised bone tenderness and bilateral symmetric proximal muscle weakness. Vitamin D-deficient osteomalacia was diagnosed based on the laboratory examination findings, which indicated high serum alkaline phosphatase, high intact parathyroid hormone, and low 25-hydroxyvitamin D levels. Her symptoms improved after oral active vitamin D and calcium administration. To the best our knowledge, this case is the first report of vitamin D-deficient osteomalacia in an adult patient due to excessive dietary restriction for managing atopic dermatitis. We emphasise the importance of increasing awareness of vitamin D deficiency as a risk factor for the development of osteomalacia, and caution against excessive avoidance of sun exposure and dietary restriction.
authors.affiliation: Department of General Medicine, Chiba University Hospital, Chiba, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Shikino
authors.affiliation: Department of General Medicine, Chiba University Hospital, Chiba, Japan.
authors.forename: Masatomi
authors.initials: M
authors.lastname: Ikusaka
authors.affiliation: Department of General Medicine, Chiba University Hospital, Chiba, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D003876:Dermatitis, Atopic / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010018:Osteomalacia / Q000175:diagnosis / Q000209:etiology*; D049268:Positron-Emission Tomography; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014808:Vitamin D Deficiency / Q000175:diagnosis / Q000209:etiology*
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