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Gaddehosur Mylaraiah R, Kanakatte Sathyanarayan S. Idiopathic hypoparathyroidism presenting as fatigue. BMJ Case Rep 2024; 17:e261135. [PMID: 39694636 DOI: 10.1136/bcr-2024-261135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024] Open
Abstract
Fatigue is a common symptom encountered in clinical practice, often posing a diagnostic challenge due to its myriad underlying causes. A comprehensive clinical history can serve as a valuable guide in such diagnostic dilemmas. A man in his 30s presented with a history of intermittent fatigue. The history of premature cataract surgery prompted an investigation for hypocalcaemia. Subsequent evaluation revealed hypocalcaemia, hyperphosphatemia and low serum parathyroid hormone. Additionally, elevated creatine kinase and lactate dehydrogenase levels were noted. Treatment with calcium and alfacalcidol yielded a favourable response. This case underscores the significance of revisiting clinical history and considering hypocalcaemia as a potential aetiology in cases of unexplained fatigue. It also emphasises the potential for overlooking the diagnosis due to the inconspicuous nature of hypocalcaemic myopathy in idiopathic hypoparathyroidism.
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Wang Z, Zhang L, Chen J. Rare skin color changes in an acute pancreatitis patient undergoing maintenance hemodialysis. BMC Nephrol 2024; 25:287. [PMID: 39227778 PMCID: PMC11370138 DOI: 10.1186/s12882-024-03738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/29/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Skin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently. CASE PRESENTATION A 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient's dialysis effluent initially appeared red. Upon examination of the patient's peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient's method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged. CONCLUSIONS In the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body.
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Affiliation(s)
- Zhen Wang
- Department of Nephrology, Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University), Shanghai, 200940, China.
| | - Lei Zhang
- Department of Nephrology, Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University), Shanghai, 200940, China
| | - Jinghan Chen
- Department of Nephrology, Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University), Shanghai, 200940, China
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Slouma M, Hannech E, Gharsallah I. Hypoparathyroidism: Musculoskeletal Manifestations Related to Parathormone Deficiency. Curr Rheumatol Rev 2024; 20:488-500. [PMID: 38279727 DOI: 10.2174/0115733971267895231227102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Hypoparathyroidism is a rare metabolic disorder that can be responsible for musculoskeletal manifestations. AIM We present a systematic review of musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database, including manuscripts describing musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. RESULTS Musculoskeletal manifestations included myopathy, shoulder disorder, immune-negative non-erosive peripheral arthritis, axial involvement simulating spondylarthritis, and diffuse ligamentous ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune diseases is possible. T-cell activation, seen in patients with hypoparathyroidism, may explain the co-occurrence of hypoparathyroidism with other autoimmune diseases. The treatment of these manifestations is based on calcium and active vitamin D supplementation. Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness. Parathyroid hormone can also promote bone formation and bone resorption by stimulating osteoclast differentiation by increasing RANKL (receptor activator for nuclear factor kappa-B ligand) expression. Therefore, hypoparathyroidism can be responsible for an increase in bone mineral density. However, the risk of fractures does not appear to be reduced due to changes in bone microarchitecture and the high risk of falls. Treatment with parathyroid hormone has been shown to improve bone microarchitecture. CONCLUSION Our review showed that musculoskeletal manifestations are frequent in patients with hypoparathyroidism, including muscular, axial, peripheral articular, and entheseal manifestations.
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Affiliation(s)
- Maroua Slouma
- Department of Rheumatology Military Hospital, El Manar University of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Emna Hannech
- Department of Rheumatology Military Hospital, El Manar University of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology Military Hospital, El Manar University of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
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Nuzhnyi EP, Antonova KV, Tanashyan MM, Illarioshkin SN. [Neurological manifestations of hypoparathyroidism: diagnostic difficulties. Case report]. TERAPEVT ARKH 2023; 95:864-869. [PMID: 38159019 DOI: 10.26442/00403660.2023.10.202429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Indexed: 01/03/2024]
Abstract
Hypoparathyroidism is a rare condition characterized by reduced production of parathyroid hormone or tissue resistance which leads to hypocalcemia and hyperphosphatemia. Neurological manifestations often occur as the first symptoms of hypoparathyroidism and are characterized by a wide variety of symptoms of both the central and peripheral nervous systems dysfunction, which requires a differential diagnosis with a wide range of neurological diseases. Two clinical cases illustrating the features of subacute and chronic hypoparathyroidism are presented. In the case of subacute hypoparathyroidism, a young woman presented with severe tetany involving the oculomotor muscles (paroxysmal strabismus), laryngeal muscles (respiratory stridor), body muscles (opisthotonus, «obstetrician's hand») and the development of secondary myopathy. In another case with a long-term chronic course of postoperative hypoparathyroidism, the patient's adaptation to severe hypocalcemia was noted; the clinical features were dominated by cerebral syndromes due to brain structures calcification (Fahr's syndrome). Possible reasons for late diagnosis of hypoparathyroidism, the importance of active detection of symptoms of neuromuscular hyperexcitability and laboratory testing of phosphorus and calcium metabolism are discussed.
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Jiwa FH, van den Hoek K, van Zeijl CJJ, Kooter AJ. A Patient with speechlessness and rhabdomyolysis: a rare presentation of severe hypocalcaemia. BMJ Case Rep 2020; 13:13/12/e238072. [PMID: 33318252 PMCID: PMC7737021 DOI: 10.1136/bcr-2020-238072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 29-year-old man with no medical history presented to our emergency department with episodes of sudden speechlessness, hoarseness, vomiting after drinking cold water and spasms of his hands. Chvostek’s and Trousseau’s signs were both seen at presentation. Blood tests revealed severe hypocalcaemia (1.03 mmol/L) and rhabdomyolysis (creatine kinase (CK) of 2962 IU/L). The patient was treated immediately with calcium intravenously with an almost immediate improvement of his voice and quick normalisation of his CK. Additional investigation showed primary hypoparathyroidism in the presence of a vitamin D deficiency, requiring lifelong treatment with calcium supplements and alphacalcidol. Severe hypocalcaemia can be life threatening and prompt treatment is essential. This case reports the unusual first presentation of hypocalcaemia via speechlessness and vomiting together with rhabdomyolysis. Identifying an atypical presentation of hypocalcaemia is critical, for it can be lifesaving.
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Affiliation(s)
- Florine Helene Jiwa
- Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Kim van den Hoek
- Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | | | - Albertus Jozef Kooter
- Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
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Ding LN, Wang Y, Tian J, Ye LF, Chen S, Wu SM, Shang WB. Primary hypoparathyroidism accompanied by rhabdomyolysis induced by infection: A case report. World J Clin Cases 2019; 7:3111-3119. [PMID: 31624762 PMCID: PMC6795733 DOI: 10.12998/wjcc.v7.i19.3111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/12/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary hypoparathyroidism (HPT) is rarely seen in the clinic, and it can be combined with rhabdomyolysis. There are few reports about this phenomenon. Therefore, it is significant to explore the etiology that is conducive to early diagnosis, timely treatment, and preventing the recurrence.
CASE SUMMARY A 63-year-old man was admitted to our hospital with a severe upper respiratory tract infection and progressing decreased myodynamia of the lower limbs. Blood tests showed creatine kinase > 32000 U/L, creatinine 207.8 µmol/L, calcium 1.28 mmol/L, myoglobin 558.7 ng/mL, and parathyroid hormone 0 pg/mL. He was diagnosed with primary HPT with rhabdomyolysis, and severe upper respiratory tract infection was considered to be the initial trigger. He responded well to supplementation of intravenous calcium gluconate and oral calcium as well as bedside hemodialysis, fluid hydration, infection control, protecting the liver, etc. Creatine kinase, myoglobin, and serum calcium returned to normal, and muscle strength improved significantly. Symptoms improved after symptomatic treatment.
CONCLUSION Severe infection should be prevented, which is the key cause of rhabdomyolysis in patients with HPT.
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Affiliation(s)
- Li-Na Ding
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Yi Wang
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Jun Tian
- Department of General Surgery, Zhangjiagang Traditional Chinese Medicine Hospital affiliated with Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
| | - Li-Fang Ye
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Shi Chen
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Shi-Min Wu
- Department of Gynecology and Obstetrics, Changshu Traditional Chinese Medicine Hospital affiliated with Nanjing University of Chinese Medicine, Changshu 215500, Jiangsu Province, China
| | - Wen-Bin Shang
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
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Salehi N, Agoston E, Munir I, Thompson GJ. Rhabdomyolysis in a Patient with Severe Hypothyroidism. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:912-918. [PMID: 28827517 PMCID: PMC5574522 DOI: 10.12659/ajcr.904691] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patient: Female, 52 Final Diagnosis: Hypothyroidism induced rhabdomyolysis Symptoms: Bilateral leg pain • fatigue Medication: Levothyroxine • Calcitriol • Calcium Gluconate Clinical Procedure: — Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Nooshin Salehi
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Endre Agoston
- Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Iqbal Munir
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Gary J Thompson
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA.,Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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Finsterer J, Löscher WN, Wanschitz J, Quasthoff S, Grisold W. Secondary myopathy due to systemic diseases. Acta Neurol Scand 2016; 134:388-402. [PMID: 26915593 PMCID: PMC7159623 DOI: 10.1111/ane.12576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 12/27/2022]
Abstract
Background Some systemic diseases also affect the skeletal muscle to various degrees and with different manifestations. This review aimed at summarizing and discussing recent advances concerning the management of muscle disease in systemic diseases. Method Literature review by search of MEDLINE, and Current Contents with appropriate search terms. Results Secondary muscle disease occurs in infectious disease, endocrine disorders, metabolic disorders, immunological disease, vascular diseases, hematological disorders, and malignancies. Muscle manifestations in these categories include pathogen‐caused myositis, muscle infarction, rhabdomyolysis, myasthenia, immune‐mediated myositis, necrotising myopathy, or vasculitis‐associated myopathy. Muscle affection may concern only a single muscle, a group of muscles, or the entire musculature. Severity of muscle affection may be transient or permanent, may be a minor part of or may dominate the clinical picture, or may be mild or severe, requiring invasive measures including artificial ventilation if the respiratory muscles are additionally involved. Diagnostic work‐up is similar to that of primary myopathies by application of non‐invasive and invasive techniques. Treatment of muscle involvement in systemic diseases is based on elimination of the underlying cause and supportive measures. The prognosis is usually fair if the causative disorder is effectively treatable but can be fatal in single cases if the entire musculature including the respiratory muscles is involved, in case of infection, or in case of severe rhabdomyolysis. Conclusion Secondary muscle manifestations of systemic diseases must be addressed and appropriately managed. Prognosis of secondary muscle disease in systemic diseases is usually fair if the underlying condition is accessible to treatment.
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Affiliation(s)
| | - W. N. Löscher
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - J. Wanschitz
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - S. Quasthoff
- Department of Neurology; Graz Medical University; Graz Austria
| | - W. Grisold
- Department of Neurology; Kaiser-Franz-Josef Spital; Vienna Austria
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Hirata D, Nagashima T, Saito S, Okazaki H, Kano S, Minota S. Elevated muscle enzymes in a patient with severe hypocalcemia mimicking polymyositis. Mod Rheumatol 2014; 12:186-9. [PMID: 24383910 DOI: 10.3109/s101650200032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract We report a case of hypocalcemic myopathy confounded by polymyositis due to an elevated level of serum creatine kinase (CK). A 30-year-old man was referred to our hospital for the treatment of provisionally diagnosed polymyositis. His presentation with tetany, hyporeflexia, and general fatigue, in addition to muscle weakness on admission, prompted us to scrutinize a blood sample in search of secondary myopathy. Blood chemistry revealed an elevated level of serum CK, marked hypocalcemia, hyperphosphatemia, and a low serum level of intact parathyroid hormone. The Ellsworth Howard test confirmed the diagnosis of hypoparathyroidism. Supplementation with calcium and 1α-hydroxyvitamin D3 improved his muscle weakness rapidly, and his serum CK level returned to the normal range. Hypoparathyroidism should be included in differential diagnoses of elevated serum CK.
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Affiliation(s)
- D Hirata
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical School , 3311-1 Yakushiji, Minamikawachi-machi, Tochigi 329-0498 , Japan
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10
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Aguiar P, Cruz D, Ferro Rodrigues R, Peixoto L, Araújo F, Ducla Soares JL. Hypocalcemic cardiomyopathy. Rev Port Cardiol 2013; 32:331-5. [PMID: 23582987 DOI: 10.1016/j.repc.2012.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 07/07/2012] [Accepted: 08/02/2012] [Indexed: 12/19/2022] Open
Abstract
The association between hypocalcemia and heart failure is rare. There are few reported cases in the literature of this association, which is termed hypocalcemic cardiomyopathy. We report the case of a 61-year-old woman with no relevant medical history, admitted for progressively worsening exertional dyspnea, orthopnea and edema of the lower limbs for a previous month. Physical examination showed diffuse muscle spasms, with no signs of latent tetany.Further investigation revealed ionized calcium 0.54 mmol/l (normal 1.12-1.30), phosphorus 9.8 mg/dl, parathyroid hormone <2.5 pg/ml and CK >3000 U/l, with normal thyroid function. The electrocardiogram showed long QT interval and a pattern of left ventricular overload, and myocardial biomarkers were negative. The echocardiogram revealed regional wall motion abnormalities, coronary angiography was normal and a cranial CT scan detected calcification of basal ganglia and white matter. She started diuretic and calcium replacement therapy which resulted in complete clinical recovery, with no need for heart failure therapy after normalization of serum calcium.
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Affiliation(s)
- Patrício Aguiar
- Serviço de Medicina 1, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal.
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11
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Hypocalcemic cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2012.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dai CL, Sun ZJ, Zhang X, Qiu MC. Elevated muscle enzymes and muscle biopsy in idiopathic hypoparathyroidism patients. J Endocrinol Invest 2012; 35:286-9. [PMID: 21508662 DOI: 10.3275/7679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study idiopathic hypoparathyroidism (IHP) myopathy and its pathogenesis by histology method. METHODS We retrospectively analyzed the clinical data of nine IHP patients during the years 2006-2010. RESULTS We found that: 1) there was an inverse relationship between the decreased serum calcium level and the elevated muscle enzymes level; 2) the IHP patients had mild-to-moderate muscle cells vacuolar degeneration and focal hyaline degeneration by hematoxylin-eosin (HE) staining; 3) except for 2 patients, the others' muscles striations were undetectable by phosphotungstic acid hematoxylin staining; 4) 2 patients with extremely high level of creatine kinase and relatively longer disease duration had muscle atrophy, multiple focal muscle fiber hyaline degeneration and sarcolemma cells hyperplasia by HE staining; 5) all patients had different degree of immune complex deposition along the muscle cell membranes by immunofluorescence staining. CONCLUSION The patients with IHP had some histological changes in skeletal muscles but with no specificity. The changes in muscles and the elevated serum muscle enzymes were related to hypocalcemia. The severity of changes in muscles was related to the duration of hypocalcemia and not only to its degree.
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Affiliation(s)
- C L Dai
- Endocrinology Department, General Hospital of Tianjin Medical University, Tianjin, China.
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Mavroudis K, Aloumanis K, Stamatis P, Antonakoudis G, Kifnidis K, Antonakoudis C. Irreversible end-stage heart failure in a young patient due to severe chronic hypocalcemia associated with primary hypoparathyroidism and celiac disease. Clin Cardiol 2010; 33:E72-5. [PMID: 20043335 PMCID: PMC6653510 DOI: 10.1002/clc.20512] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 07/30/2008] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic hypocalcemia may cause electrocardiographic (ECG) changes and mimic acute myocardial infarction. It has also been associated with reversible cardiac dysfunction. On the other hand cardiomyopathy and heart failure have been reported in patients with idiopathic hypoparathyroidism or celiac disease. CLINICAL CASE A 39-year-old male was admitted to the emergency room with acute retrosternal pain and dyspnea. He exhibited severe hypocalcemia and acute renal failure. High creatine kinase (CK) levels did not correlate with biomarkers of myocardial necrosis (negative troponin test, heart type creatine kinase isoenzyme (CK-MB) < 1% of CK value). The ECG showed an extremely long QT interval (0.6 sec) and T-wave inversions on V(4) through V(6). The left ventricular ejection fraction (LVEF) was as low as 25%, while coronary angiography was normal. Investigation of the hypocalcemia revealed primary hypoparathyroidism (Parathyroid hormone (PTH) < 3 pg/ml) and concomitant celiac disease with positive antigliadin and endomysial antibodies. The cardiovascular episodes and the dilated heart failure were attributed to the chronic hypocalcemia since no other cause was found. The correction of hypocalcemia has not been sufficient to reverse the end-stage heart failure after more than 6 months of treatment, even though ECG abnormalities have receded, implying permanent cardiac impairment. CONCLUSION This case demonstrates an unusual clinical condition where 2 calcium homeostasis disorders led to severe hypocalcemia with clinical manifestations of end-stage heart failure. The severe cardiac failure appeared to be nonreversible after calcium repletion suggesting permanent cardiac muscle dysfunction due to associated cardiomyopathy.
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Affiliation(s)
| | | | - Panagiotis Stamatis
- Department of Cardiology, General Hospital “Asklipieion”, Voula, Athens, Greece
| | - George Antonakoudis
- Department of Cardiology, General Hospital “Asklipieion”, Voula, Athens, Greece
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15
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Tanemoto M, Uruno A, Abe T, Ito S. Hypocalcemia in a patient with severe hypertension and surgically induced relative hypoparathyroidism. J Bone Miner Metab 2008; 26:298-300. [PMID: 18470673 DOI: 10.1007/s00774-007-0817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 09/07/2007] [Indexed: 11/28/2022]
Affiliation(s)
- Masayuki Tanemoto
- Department of Medicine, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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Naderi ASA, Palmer BF. Rhabdomyolysis and acute renal failure associated with influenza virus type B infection. Am J Med Sci 2006; 332:88-89. [PMID: 16909056 DOI: 10.1097/00000441-200608000-00007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A patient with rhabdomyolysis-induced acute renal failure due to influenza B virus infection is presented. Influenza B infection caused rhabdomyolysis with efflux of myoglobin from myocytes, causing acute renal failure. In conclusion, influenza virus type B can cause severe rhabdomyolysis leading to acute renal failure.
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Affiliation(s)
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Toprak Ö, Üzüm A, Ersoy R, Cirit M. HYPOCALCEMIA INDUCED RHABDOMYOLYSIS AND ACUTE RENAL FAILURE AFTER THYROIDECTOMY: A CASE REPORT. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2005. [DOI: 10.29333/ejgm/82273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Olczak T, Simpson W, Liu X, Genco CA. Iron and heme utilization in Porphyromonas gingivalis. FEMS Microbiol Rev 2005; 29:119-44. [PMID: 15652979 DOI: 10.1016/j.femsre.2004.09.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 06/18/2004] [Accepted: 09/02/2004] [Indexed: 11/26/2022] Open
Abstract
Porphyromonas gingivalis is a Gram-negative anaerobic bacterium associated with the initiation and progression of adult periodontal disease. Iron is utilized by this pathogen in the form of heme and has been shown to play an essential role in its growth and virulence. Recently, considerable attention has been given to the characterization of various secreted and surface-associated proteins of P. gingivalis and their contribution to virulence. In particular, the properties of proteins involved in the uptake of iron and heme have been extensively studied. Unlike other Gram-negative bacteria, P. gingivalis does not produce siderophores. Instead it employs specific outer membrane receptors, proteases (particularly gingipains), and lipoproteins to acquire iron/heme. In this review, we will focus on the diverse mechanisms of iron and heme acquisition in P. gingivalis. Specific proteins involved in iron and heme capture will be described. In addition, we will discuss new genes for iron/heme utilization identified by nucleotide sequencing of the P. gingivalis W83 genome. Putative iron- and heme-responsive gene regulation in P. gingivalis will be discussed. We will also examine the significance of heme/hemoglobin acquisition for the virulence of this pathogen.
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Affiliation(s)
- Teresa Olczak
- Institute of Biochemistry and Molecular Biology, Laboratory of Biochemistry, Wroclaw University, Tamka 2, 50-137 Wroclaw, Poland.
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Nora DB, Fricke D, Becker J, Gomes I. Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:154-7. [PMID: 15122452 DOI: 10.1590/s0004-282x2004000100028] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Myopathy due to idiopathic hypoparathyroidism is very unusual. We report on a 30 years-old man referred with complaints of sporadic muscle pain and mild global weakness for 10 years. His physical examination showed normal strength in distal muscle and slightly weakness in the pelvic and scapular girdles with no atrophy. Deep muscle reflexes were slightly hypoactive. Trousseau's and Chvostek's signs were absent. He had bilateral cataract and complex partial seizures. His laboratory tests showed decreased ionised and total calcium and parathyroid hormone and increased muscle enzymes. EMG and muscle biopsy was compatible with metabolic myopathy. After treatment with calcium and vitamin D supplementation he showed clinical, neurophisiological and laboratorial improvement. In conclusion: patients with muscle symptoms, even when non-specific and with normal neurological examination, should have serum calcium checked, as myopathy due to idiopathic hypoparathyroidism, even being rare, is treatable and easy to diagnose.
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Affiliation(s)
- Daniel Bocchese Nora
- Neurology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
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Kuno N, Ishikawa K. Serum creatine phosphokinase elevation in patients treated with intravenous magnesium sulfate. Int J Gynaecol Obstet 2002; 76:257-66. [PMID: 11880128 DOI: 10.1016/s0020-7292(01)00582-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE During the treatment of pre-term labor with magnesium sulfate, we noted an abnormal elevation of maternal serum creatine phosphokinase. This study was aimed at evaluating the relationship between tocolysis with MgSO4 and maternal serum CPK elevation, which represents the possible damage of muscles by magnesium sulfate. METHODS Clinical records of 45 women treated with magnesium sulfate and beta-sympathomimetics for the treatment of pre-term labor were retrospectively examined. RESULTS Serum CPK was abnormally elevated in 32 out of 45 cases (71.1%), but in only one out of 21 in the control group. In three cases, the decrease of serum creatine phosphokinase after cessation of magnesium sulfate was demonstrated, despite the continuous infusion of beta-sympathomimetics. CONCLUSION Magnesium sulfate may cause muscular damage and abnormal elevation of maternal serum creatine phosphokinase. Special attention must be paid to patients when drugs acting on muscle cells, for example succinyl choline, are going to be used.
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Affiliation(s)
- N Kuno
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
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Kodatsch I, Finsterer J, Stöllberger C. Serum creatine kinase elevation in a medical department. ACTA MEDICA AUSTRIACA 2001; 28:11-5. [PMID: 11253625 DOI: 10.1046/j.1563-2571.2001.01003.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Serum creatine kinase (CK) levels are diagnostic markers for acute myocardial infarction. Many other causes however, including neuromuscular disorders, may induce serum CK elevation as well. Aim of the study was to investigate the prevalence of potential causes for serum CK elevation in a medical department. In particular we were interested in the recognition of patients in whom serum CK elevation was due to a neuromuscular disorder. Included in this prospective study were 100 consecutive patients in whom the CK level, determined at admission, was increased (> 70 IU/l in female, > 80 IU/l in male patients). After admission we looked for the presence of causes known to induce CK elevation. Patients with no potential cause for CK elevation were invited for follow-up investigations three months later. If no potential cause could be found and if CK was elevated again on this occasion, the patient was referred for a comprehensive neurological investigation. The prevalence of patients with CK elevation was 11.2%. The 100 patients (44 female, 56 male) were aged from 23 to 94 (mean 67) years. In 95% CK elevation was only up to 500 IU/l. The most frequent cause for serum CK elevation was acute myocardial infarction in 32%. Further frequent causes were drug intake (32%), fall (24%), haematoma (17%), intramuscular injection (16%) and malignancy (11%). In 61% of the cases at least two potential causes for serum CK elevation could be detected. Neuromuscular disorders were found in only 2%. This study shows that serum CK elevation occurs in 11% of patients admitted to a medical department and can be explained by acute myocardial infarction in only 32%. In almost two thirds of the patients, more than one potential cause for serum CK elevation can be found thus making CK elevation a rather unspecific finding. Neuromuscular disorders are rarely found as a cause of serum CK elevation in a medical department.
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Affiliation(s)
- I Kodatsch
- 2nd Medical Department, Krankenanstalt Rudolfstiftung, Vienna
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Roca B, Mínguez C, Sáez-Royuela A, Simón E. Dementia, myopathy, and idiopathic hypoparathyroidism. Postgrad Med J 1995; 71:702. [PMID: 7494783 PMCID: PMC2398351 DOI: 10.1136/pgmj.71.841.702-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Lawrence IG, Lear J, Burden AC, Maddocks E, Smith JF. Hyperglycaemia induced by paracetamol. Postgrad Med J 1995; 71:702. [PMID: 7494784 PMCID: PMC2398353 DOI: 10.1136/pgmj.71.841.702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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