Cardiogenic Shock in a Toddler With Rickets

Area of Science:

• Pediatric Cardiology
• Pediatric Endocrinology
• Nutritional Deficiencies

Background:

• Dilated cardiomyopathy (DCM) in children is usually idiopathic, genetic, or infectious.
• Rarely, DCM can be secondary to vitamin D-deficient rickets, presenting with severe cardiac dysfunction.
• Severe rickets can manifest with hypocalcemia, skeletal deformities, and potentially cardiogenic shock.

Purpose of the Study:

• To report a case of pediatric DCM secondary to vitamin D-deficient rickets.
• To highlight the diagnostic challenges and management of this rare condition.
• To emphasize the potential for cardiac recovery with timely intervention.

Main Methods:

• Case report of a 16-month-old male with DCM and cardiogenic shock.
• Diagnostic workup included laboratory tests for hypocalcemia and vitamin D levels, and radiographic skeletal surveys.
• Management involved mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA ECMO) and a left ventricular assist device (LVAD), alongside aggressive vitamin D and calcium repletion.

Main Results:

• The patient presented with severe left ventricular dysfunction, hypotension, and hypocalcemia.
• Diagnosis of vitamin D-deficient rickets was confirmed by low vitamin D levels and characteristic radiographic findings.
• Despite initial aggressive treatment, VA ECMO was required, followed by LVAD support. Cardiac function gradually normalized, allowing for device explantation after 95 days.
• The patient recovered normal left ventricular function at 1-year follow-up, despite a stroke during LVAD support.

Conclusions:

• Vitamin D-deficient rickets is a rare but reversible cause of pediatric DCM.
• Left ventricular assist device (LVAD) support can serve as a bridge to recovery in severe rickets-associated DCM.
• Early recognition and comprehensive management are crucial for improving outcomes in these patients.