Abstract
A 5-year-girl of South Asian descent, born at term to nonconsanguineous parents, presented with nontraumatic bony pains and inward bending of the knees. She had minimal dietary calcium intake, 5 min/day of sunlight exposure, conservative dressing pattern, and noncontributory past or family history. Clinical examination revealed wrist widening, double malleoli, rachitic rosary, and bilateral genu valgus with no joint swelling, tenderness, or crepitus. Laboratory investigations showed the following: serum calcium, 7.4 mg/dL (8.8–10.8 mg/dL); phosphorus, 2.6 mg/dL (4–7 mg/dL); 25OHD, <4 ng/mL; and intact parathyroid hormone (iPTH), 1220 pg/mL (11.7–61.1 pg/mL).
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