Osteomalacia secondary to renal tubular acidosis due to Sjögren's syndrome: a case report and review of the literature

CEN Case Reports
Hiroshi NagaeRitsuko Katafuchi

Abstract

A 43-year-old woman was admitted to our hospital because of generalized bone pain. Arterial blood gas showed pH 7.266, HCO3(-) 13.5 mEq/l, and anion gap (AG) 12. Since her urine pH was 7.0 despite metabolic acidosis with normal AG, we diagnosed distal renal tubular acidosis (RTA). Serum phosphate was 2.5 mg/dl, the level of β2 microglobulin was 41100 μg/l, and aminoaciduria was present. These results indicated proximal tubular dysfunction. The radiograph showed pseudofracture in the pubic bone, indicating osteomalacia. Bone scintigram showed abnormal accumulations of 99mTc-HMDP in multiple joints. Then, her generalized bone pain was considered to be a symptom of osteomalacia. Despite the absence of overt Sicca syndrome, the evaluation of Sjögren's syndrome (SjS) as a cause of distal RTA was performed. Antibodies to the SS-A level was 127U/ml. Tear break-up time was 3 s bilaterally and salivary gland scintigraphy showed low uptake of 99mTc in the submandibular glands and the parotids. Thus, we diagnosed SjS finally. Gallium scintigraphy showed mild abnormal uptake in bilateral kidneys, suggesting acute tubulointerstitial nephritis. After treatment with prednisolone, alfacalcidol, and sodium bicarbonate, bone pain was remarkably ...Continue Reading

References

Apr 1, 1970·The American Journal of Medicine·R ShiojiY Sasaki
May 29, 2000·QJM : Monthly Journal of the Association of Physicians·K AasarødS Jørstad
Apr 28, 2004·Archives of Internal Medicine·Milford Fulop, Meggan Mackay
Jul 17, 2004·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·C Díaz RodríguezE Granja Romero
Oct 18, 2005·Joint, Bone, Spine : Revue Du Rhumatisme·Bouchra SaoudNajia Hajjaj-Hassouni
Nov 10, 2006·Rheumatology International·Yi-Sun YangChien-Ning Huang

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Citations

May 1, 2021·Journal of Clinical Medicine·Meletios RozisDimitrios Stergios Evangelopoulos

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