Hypophosphatemic osteomalacia due to cadmium toxicity in silverware industry: A curious case of aches and pains

• Published in: Journal of family medicine and primary care Vol. 13; no. 6; pp. 2516 - 2519
• Main Authors: Roy, Ayan, Saha, Taurja, Sahoo, Jayaprakash, Das, Abanti
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow 01.06.2024; Wolters Kluwer Medknow Publications
• Edition: 2
• Subjects: cadmium; Case Report; heavy metal; hypophosphatemia; nephropathy; osteomalacia; Cadmium; osteomalacia; heavy metal; nephropathy; hypophosphatemia
• ISSN: 2249-4863; 2278-7135
• DOI: 10.4103/jfmpc.jfmpc_1836_23

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.