Abstract
A child age 9 years complained of pains in both legs from November 1975 and was unable to walk 1 month later. On clinical examination he had pain on pressure over L3 and L4 lumbar vertebrae, but no other abnormal clinical findings. Body height 142 cm (90th percentile). The following tests were abnormal: serum phosphorus (P) 3.6-4.0mg/dl, UP/UCr 0.88-1.1. X-ray showed a collapse of L4. The patient was put in a plaster jacket and started on 2g of phosphorus daily by mouth. 3 months later he was able to walk again and in another 7 months painfree and the plaster was removed. His height was 145 cm (90th percentile), serum Ca 11 mg/dl, serum P 3.7 mg/dl UCa0.07/UCrL4. UP/UCr 1.15:x-ray of spine showed a marked improvement of L4. The patient was put in a plaster jacket and started on 29 of phosphorus daily by mouth. 3 months later he was able to walk again and in another 7 months painfree and the plaster was removed. His height was 145 cm (90th percentile), serum Ca11 mg/dl, serum P 3.7 mg/dl The treatment with oral administration of phosphate was continued and the patient reviewed 12 months after removal of his plaster in September 1977. X-ray showed a continuing improvement of L4, serum Ca 9.9 mg/dl, serum P 4.3 mg/dl, urinary Ca and P excretion in 24 hours 73 and 1385 mg respectively. One year later in September 1978 whilst still on phosphate therapy his results were serum Ca 9.7 mg/dl, serum P 4.3 mg/dl and x-ray improvement in shape of L4. This condition seems to be due to a renal tubular handicap for handling P resulting in phosphaturia but producing only an isolated bone lesion without rickets. Since there is healing with phosphate alone and his father also has abnormal phosphaturia but no bone lesions it could be an atypical form of vitamin D dependent rickets.
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Dafforn-Ierodiakonou, E., Morakis, A., Vretos, C. et al. Hyperphosphaturia producing collapse of vertebral body: 40. Pediatr Res 14, 172 (1980). https://doi.org/10.1203/00006450-198002000-00067
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DOI: https://doi.org/10.1203/00006450-198002000-00067