Vitamin A toxicity presenting as bone pain.
A 4-year-old boy presented with severe bone pains, refusal to walk, diffuse bony swelling of forelimbs, skin changes and abdominal pain, with symptoms evolving over 6 weeks. Blood screening tests were normal except for raised aspartate aminotransferase (AST). Radiographs revealed thickened periosteum, widening of the diaphyses of long bones and lifted periosteum in mid-shaft of ulnae and right femur. Skeletal scintigraphy showed a high uptake of radionuclide at clinically affected and unaffected sites, suggestive of multifocal osteoblastic skeletal lesions. After repeated enquiries, his parents admitted to giving him massive doses of preformed vitamin A for over 3 months as 'health tablets'. Surprisingly, he did not have overt liver disease typically found with much smaller doses, although the dermal changes and musculoskeletal pathology were florid. He made a full clinical recovery within 2 months of cessation of vitamin A.
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Revanth
R
Baineni
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Reena
R
Gulati
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Cg Kumar
CK
Delhi
D001847:Bone Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D002675:Child, Preschool; D004334:Drug Administration Schedule; D006801:Humans; D006986:Hypervitaminosis A / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D010146:Pain / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011859:Radiography; D011877:Radionuclide Imaging; D014801:Vitamin A / Q000008:administration & dosage
D014801:Vitamin A
Vitamin A toxicity; bone pains; oily skin; raised periosteum; skeletal scintigraphy