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- Title
Hypophosphatemic osteomalacia due to cadmium toxicity in silverware industry: A curious case of aches and pains.
- Authors
Roy, Ayan; Saha, Taurja; Sahoo, Jayaprakash; Das, Abanti
- Abstract
Hypophosphatemic osteomalacia in an adult often gives clinical diagnostic challenges. Usually, they are caused by either tumor‑induced osteomalacia or due to genetically mediated hypophosphatemia, particularly X‑linked hypophosphatemia. However, heavy metal toxicity, leading to global proximal renal tubular dysfunction, is a rare cause, and in particular, cadmium toxicity is rarely encountered in clinical practice. The presence of bony pain and neurological deficit, along with a classical exposure history, provides the diagnostic clue. In this background, here we present a middle‑aged man who had severe bony pains all over his body and lower back stiffness for five years. He underwent an initial workup as a suspected spondyloarthropathy but was later on, found to have hypophosphatemic osteomalacia and severe proximal renal tubular dysfunction. Further, the workup revealed elevated FGF‑23. His occupational history revealed prolonged exposure to cadmium fumes in the silverware industry. He improved moderately with treatment; however, significant renal damage is still present. This case highlights the importance of considering cadmium toxicity in proper clinical and occupational contexts in the evaluation of hypophosphatemic osteomalacia in an adult.
- Subjects
HEAVY metal toxicology; HEAVY metals; KIDNEY diseases; HYPOPHOSPHATEMIA; CADMIUM; RENAL tubular transport disorders; OSTEOMALACIA
- Publication
Journal of Family Medicine & Primary Care, 2024, Vol 13, Issue 6, p2516
- ISSN
2249-4863
- Publication type
Case Study
- DOI
10.4103/jfmpc.jfmpc_1836_23