HIV infection and Osteomalacia: when all is not due to HIV

• Autor(a) principal: Rodrigues, Patrícia
• Data de Publicação: 2008
• Outros Autores: Pimenta da Graça, José, Corredoura, Ana Sofia, Pacheco Pereira, João, Rodrigues, Gabriela, Almeida, Odette
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1456
• topic: Vitamina D; osteomalacia; infecção VIH; Vitamin D; osteomalacia; HIV infection

Osteomalacia caused by vitamin D deficiency, is an osteometabolic disease, not frequent in Portugal. The disease has several aetiologies and assumes special importance in patients with multiple risk factors. Due to the difficulty in identifying the disease, a high level of suspicion is required in order to make the diagnosis.We described the clinical case of a 33 year-old man, infected with human immunodeficiency virus (HIV), with progressive multifocal leukoencephalopathy for 6 years. The patient was partially dependent for daily living activities and was admitted for aetiological evaluation of bone pain and decreased muscular strength, progressively intensifying over the course of one year. Abnormal images were seen on a bone scan.The evidence of multiple risk factors for vitamin D deficiency, the presence of hypophosphatemia and imaging issues, raised the suspicion of osteomalacia due to vitamin D deficiency. This diagnosis was confirmed: analytically (low level of vitamin D metabolites), histologically and by therapeutic response.A brief review is made of the factors influencing vitamin D bone metabolism and their importance in maintaining a proper immunological response. It is mentioned that the absence of clinical suspicion may be responsible for many undiagnosed cases.In patients infected with HIV who present with an obscure clinical picture, we should also consider pathological entities not directly in relation to immunodeficiency, as they may be treated and have a better prognosis.