Granuloma annulare and vitamin D resistant rickets

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The etiology of granuloma annulare is not known. An association between granuloma annulare and diabetes mellitus has often been suggested. Rhodes et al,1 using a prednisone stress test detected abnormal glucose tolerance in 3 of 30 patients with granuloma annulare. Wells and Smith2 reported that of 115 patients with granuloma annulare only 3% were diabetic. We report the first case in the literature of granuloma annulare in a patient with vitamin D resistant rickets.

Case report

A 43-year-old white woman was seen at the Cleveland Clinic in December 1971. She had a 1-year history of low back and anterior trunk pain, and she was found to have hypophosphatemia and glycosuria.

Laboratory studies disclosed the following values: serum phosphorus 1.3 mg/100 ml (normal 2.5–4.5); serum calcium 9.3 mg/100 ml (normal 8.5–10.5); serum alkaline phosphatase 20 King-Armstrong units/100 ml (normal 4–17). Results of a 5-hour glucose tolerance test were normal with glycosuria at 1, 2, and 3 hours. A 24-hour urine specimen had a normal calcium, phosphorus, and amino acid chromatogram. The creatinine clearance was 110 ml/min. The antinuclear factor (ANF), latex fixation test, VDRL test for syphilis, LE test, serum protein electrophoresis, chest and spine roentgenograms and determinations of urine lead, urine 17-ketosteroids, and urine 17-hydroxycorticoids were normal.

The diagnosis of vitamin D resistant rickets was made and the patient was discharged January 1972 on a regimen of 50,000 units of vitamin D and 2 g phosphosoda orally daily.

Two months after hospital discharge (March 1972) the patient’s. . .



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