A case of bilateral Achilles tendon spontaneous rupture in a hemodialysis patient: Who is the real culprit? Acidosis? Or hyperparathyroidism?

Saifullah Khan, Muftah Othman, Mohammad Amin Elesnawy

Keywords: Achilles tendon, Hemodialysis, High β-2 macroglobulin, Hyperparathyroidism, Rupture

DOI: 10.32677/yjm.v1i2.3642

DOI URL: https://doi.org/10.32677/yjm.v1i2.3642

Publish Date: 29-03-2025

Pages: 100 - 102

Views: 3

Downloads: 7

Author Affiliation:

From ¹Consultant,

²Resident, Department of Medicine-Nephrology Unit, Hamad Medical Corporation, Doha, Qatar

Abstract

Patients who are on regular hemodialysis and who have advanced renal failure but have not yet started on renal replacement therapy have a high risk of tendon rupture, although this is a rare situation. We reported a case of 55-year-old male patient who had been on regular hemodialysis for the past 10 years. He presented with a sudden onset of pain and swelling in the left posterior ankle while climbing stairs. Ultrasonography revealed a complete disruption of the Achilles tendon, which was surgically repaired. His medical history was remarkable for the right Achilles tendon rupture a year ago. Investigations revealed tertiary hyperparathyroidism with chronic metabolic acidosis and high β-2 macroglobulin. With surgical repair, physiotherapy, and parathyroidectomy, the patient regained full active mobility. This case emphasized the importance of high parathyroid hormone level, metabolic acidosis, and high β-2 macroglobulin in the pathogenesis of tendons ruptures.