Spinal Cord Compression as the First Presentation of Primary Hyperoxaluria in a Patient With Kidney Failure: A Case Report and Literature Review

Abstract

A 50-year-old woman with kidney failure complained of back pain and an inability to walk. The medical history included hypothyroidism, nephrolithiasis, and resistant anemia aligned with several transfusions. The examination showed hepatosplenomegaly, lower limb weakness, absence of reflexes, and lack of sensations with a sensory level T6. Laboratory results showed hypercalcemia with suppression of parathyroid hormone levels. Magnetic resonance imaging showed vertebral fractures and mass-like lesions that compressed the spine at T4, T9, L4, and L5. Vertebral and bone marrow biopsies showed calcium oxalate (CaOx) depositions. Here, we reported a rare case of primary hyperoxaluria (PH) in a patient with kidney failure who presented with spinal cord compression caused by vertebral fractures and mass-like lesions. We summarized a literature review of PH patients with spinal cord compression, which showed only 3 cases. The multiorgan CaOx infiltration in this patient also caused resistant anemia, hepatosplenomegaly, extensive bone lesions, hypoparathyroidism, hypothyroidism, and hypercalcemia. The overdiagnosis of renal osteodystrophy and the negative family history could delay the diagnosis of PH in patients with kidney failure. Thus, clinicians should always consider PH in the differential diagnosis of kidney failure patients with stone events given that the early diagnosis of PH could be lifesaving.