Maternal vitamin D deficiency: a culprit for hypocalcaemia induced myocardial failure in a four-month old infant: a case report from Tikur Anbessa Specialized Hospital, Ethiopia

Abstract

BACKGROUND: A rare but reversible cause of dilated cardiomyopathy occurs in infants born to vitamin D deficient mothers due to hypocalcaemia. CASE REPORT: We report a case of dilated cardiomyopathy due to hypocalcaemia secondary to maternal vitamin D deficiency in an infant presented with seizure disorder and heart failure. This was a four-month old female infant with respiratory distress and acute heart failure. The cause of her cardiac failure was dilated cardiomyopathy. Concomitant community acquired pneumonia was diagnosed on chest X ray. Despite treatment, the infant's clinical condition worsened. The mother was found to be housebound, dark skinned and veiled while going outside of home. Laboratory studies revealed hypomagnesaemia and hypocalcaemia. The vitamin D levels of both the infant and the mother were found to be low. The infant was treated for the deficiency state until her cardiac condition fully recovered. CONCLUSION: This case report demonstrated the direct relationship between maternal vitamin D deficiency and the infant's acute heart failure. It also highlighted the importance of vitamin D supplementation during pregnancy in order to prevent the cardiac complication of maternal vitamin D deficiency in the infants.

Hypocalcemic Cardiomyopathy - a Rare Heart Failure Etiology in Adult

“…Hypocalcemic heart failure is a rare finding in clinical practice. It was described especially in infants, due to severe vitamin D deficiency (6)(7)(8). Hypocalcemic ventricular dysfunction and dilatation in adulthood is substantially less found and described, being mainly related to hypoparathyroidism (9)(10)(11).…”

Clinical, biochemical, and echocardiographic evaluation of neonates with vitamin D deficiency due to maternal vitamin D deficiency

“…In small-scale studies and a limited number of case reports, dilated cardiomyopathy and electrocardiographic changes (T wave abnormalities, prominent U wave, and long QT interval) have been reported, and which completely recovered after supportive therapy of heart failure along with treatment of vitamin D deficiency. [10][11][12]15,22,24,25 In the majority of the cases, the diagnosis was delayed for up to 1 year. Therefore, a diagnosis of rickets as an underlying aetiology has been made after excluding other etiologies and observing improvement of cardiac function in response to treatment for cardiac failure, dilated cardiomyopathy, and rickets.…”

“…We compared the biochemical and echocardiographic parameters of the present cohort with those of previously published 27 patients with confirmed dilated cardiomyopathy due to vitamin D-deficient rickets (historical group). [12][13][14][18][19][20][21][22][23][24][25][26][27][28][29]…”