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

Abstract

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.