Urban life style has made Vitamin D deficiency very common. It is clinically presenting with varied symptoms from seizures in  neonates to bone pains & fractures in old age patients.

A 2-year-old girl presented to the pediatrics clinic with both leg pain and bowed legs. She has been healthy without recent sickness. She was the 2nd child of her family(G2P2), born full term (39 weeks gestation) without any complications and breastfed up to 12 months. The parents reported no history of seizures. No genetic disorder history in family.

The father told that his daughter had not gained weight and was much shorter than her sister was at this age. The 4-year-old sister started  walking by eighteen months, but the patient required some assistance when bearing weight on her legs. Both children were on the same diet. There was a history that she spent most of the time inside the home and did not play outside in the sunlight. The patient had not had fevers or rash and vaccinated for age.

On clinical examination Bowed legs or knock knee, swollen wide wrist and knee, soft skull, short stature, palpable nodules at the costochondral junction of chest, bone pain, and motor developmental delay were present in the child. Blood workup including CBC, Calcium, ALP, PTH,  iPTH, Vitamin D were ordered.

X-ray of wrist and knee Anteroposterior (AP) and Lateral View radiographic findings revealed bowing of the lower extremities and metaphyseal cupping and fraying. These findings correlated with serum studies of low total serum calcium (7.0 mg/dl) and low serum vitamin D levels (5 ng/ml), High PTH (250pg/ml).

Imaging studies and laboratory findings both confirmed the diagnosis of calcipenic Rickets (vitamin D deficiency, Low Calcium). Girl was treated with Vitamin D3 60,000 international unit weekly for 6 weeks along with calcium supplement (daily intake of 1000 mg of calcium). an oral calcium supplement should be prescribed to avoid “hungry bone” syndrome. Father was counselled for adequate sun exposure to the children.

On follow up after 3 months patient improved clinically and radiologically. Children who do not respond despite adherence to treatment may have a defect in vitamin D absorption or metabolism, or increased catabolism.

Author- Dr. Abhinendra singh, Dr. Rajshree