ESPE Abstracts

Context: Nutritional vitamin D deficiency is rare in the high income countries; its manifestations are usually associated with the combination of accompanying risk factors, as malnutrition, chronic illness, dark skin or restricted exposure to sunlight due to cultural practices.

Objective: The aim of this case report is to increase the awareness to severe vitamin D deficiency as a result of extreme indoor isolation due to the COVID-19 pandemic.

Subject and Results: The patient is a 12.5 year healthy white-skinned teenager from a high social level family in a sunny developed country. During a family first outdoor weekend following nearly one year of indoor isolation he experienced breathing difficulties, myalgia, paresthesia, perioral and carpal spasms, which matches signs of hypocalcemic seizures. Biochemical evaluation revealed undetectable level of 25-hydroxyvitamin D (sufficiency >30ng/ml), serum calcium level of 6.8 mg/dl (8.8-10.4), phosphorus level of 7.4mg/dl (3.0-5.9), alkaline phosphatase 850U/L (80-405), PTH level 94pg/ml (6.5-36.8), albumin 4.2g/dl (3.5-5.5). Renal function tests were normal. Vitamin D therapy was initiated by his primary care physician with 1000 units/day. One month later his calcium level increased to 8.8 mg/dl and 25-hydroxyvitamin D to 9.5ng/ml, while phosphorus level decreased to 6.7mg/dl, alkaline phosphatase to 738U/L and PTH to 74.1pg/ml.

Conclusions: This case illustrates severe vitamin D deficiency as another consequence of COVID-19 pandemic and prolonged indoor isolation even in sunny high income countries. It is imperative to encourage patients for daily sunlight exposure or to use vitamin D supplements.