OSTEOMALACIA AS A PRESENTING MANIFESTATION OF SJOGRENS-SYNDROME

Osteomalacia is still common in Morocco, where the leading causes are nutritional deficiencies followed by intestinal diseases. Osteomalacia rarely occurs as the first manifestation of a renal tubule disorder d ue to a connective tissue disease such as Sjogren's syndrome. The case of a 40-year-old woman who presented with a five-year history of gene ralized bone pain, severe weight loss and a waddling gait is reported. She had low levels of serum phosphate (0.74 mmol/L), serum calcium (1 .97 mmol/L), and urinary calcium (1.22 mmol/24 h). Serum alkaline phos phatase was 210 IU/L. Roentgenograms showed Looser's zones (right femo ral neck, sixth and seventh right ribs). There was bilateral parotid g land enlargement, dryness of the mouth, nose and eyes, and bilateral p unctate keratitis. A lip biopsy showed changes corresponding to stage II of the Chisholm and Mason classification. Tests for rheumatoid fact or (latex and Waaler-Rose) and antinuclear factor were negative. The a lkaline reserve was 18 mmol/L, serum potassium was 3.5 mmol/L, serum c hloride was 112 mmol/L and urinary pH was 6.5. A renal biopsy showed t ubulointerstitial lesions, lymphoplasmocytic infiltrates and interstit ial sclerosis with patchy tubular atrophy. The patient was given bicar bonates, high-dose vitamin D followed by 1-alpha-hydroxycholecalcifero l (0.3 mu g/d), and calcium (1 g/d). Follow-up was 42 months at the ti me of this writing. The role of tubular disorders in the genesis of os teomalacia is discussed, and the renal manifestations of Sjogren's syn drome are reviewed.