Presentation
Wadling gait for 8 months.
Patient Data
Anterior bowing of the distal femoral diaphysis bilaterally.
Femoral, tibial and fibular metaphyses show broadening, cupping and splaying.
Laboratory results revealed vitamin D deficiency, hypocalcemia and markedly elevated alkaline phosphatase in keeping with bone resorption.
serum calcium = 8.8 mg/dL (normal range 8.8 to 10.3 mg/dL)
alkaline phosphatase = 1088 IU/L (normal range 44 to 147 IU/L)
vitamin D3 = 6.9 ng/mL (normal range 20 to 50 ng/mL)
Case Discussion
Radiographic features and laboratory results are in keeping with active vitamin D deficiency rickets (nutritional). Changes are most evident around the knee. The patient has history of prematurity which is one of the risk factors for the disease.
It is becoming rare now due to prescribing prophylactic Vitamin D to children in a nutritional dose and it is also added to milk and some foods.
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