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AB1084 Bone oxalosis in a patient with chronic renal failure: About a new case
  1. Y. Ben Ariba,
  2. I. Gharsallah,
  3. S. Sayeh,
  4. J. Laabidi,
  5. L. Metoui,
  6. F. Ajili,
  7. N. Ben Abdelhafidh,
  8. R. Battikh,
  9. B. Louzir,
  10. S. Othmani
  1. Military Hospital of Tunis, Monfleury, Tunisia

Abstract

Background Primary hyperoxaluria Type 1 is a congenital metabolic disease characterized by exaggerated production of oxalic acid. It is due to the deficiency of the hepatic enzyme, the alanine- glyoxylate aminotransferase. Calcium oxalate deposits may occur in several organs espacielly in kidneys, bones and soft tissus. Bone oxalosis is rare.

Methods We report a new case of bone oxalosis collated in the internal medecine departement of the Military Hospital of Tunis.

Results A twenty-one-year-old man was admitted for exploration of an end-stage renal failure. He had been on maintenance hemodialysis. He complained diffuse polyarthralgia and proximal bone pain. Physical examination revealed an average general state, an ascites, oedema of lower limbs and hepatomegaly. Joints were not painful. A liver biopsy was performed and closes in the diagnosis of primary oxalosis with deficiency of alanine- glyoxylate aminotransferase. The assay of oxalic acid was 8.4 mg/l (normal between 1.3 mg/l and 2.3 mg/l). Radiological examinations showed cortical erosions at metacarpophalangeal joints and phalanges, in addition to increased density area surrounded by areas of demineralization in carpal bones. In long bones, there were cortical defects associated to metaphyseal and epiphyseal mesangial sclerosis bands. Percutaneous iliac crest biopsy was performed and revealed large numbers of oxalate crystals within the medullary space with giant-cell granulomas, fibrosis and trabeculae rarefaction.The crystals were arranged in a radial rosettelike pattern and were birefringents under polarized light. These changes were associated with features of secondary hyperparathyroidism.

Conclusions Bone oxalosis is rare, it was described since 1950. Radiological abnormalities are various. It also stresses that bone oxalosis may mimick secondary hyperparathyroidism, especially radiologically. Differential diagnosis is therefore mandatory and diagnosis should be anatomopathological.

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  2. Salyer WA, Keren D. Oxalosis as a complication of chronic renal failure. Kidney lnt 1973;4:61-66

  3. Carsen GM, Radkowski MA. Calcium oxalosis. Radiology 1974

  4. Gherardi G, Poggi A, Sisca 5, Calderaro V, Bonucci E. Bone oxalosis and renal osteodystrophy: a histopathological, histochemical and ultrastructural investigation. Arch Pathol

Disclosure of Interest None Declared

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