There are many cases which have been reported in the literature regarding rickets in early childhood, as it is more common in this age group. The most common presentations are bony deformities such as bow legs and fractures, stridor1
due to hypocalcaemia. There are some case reports about adolescent patients who were diagnosed with vitamin D deficiency rickets, and they are usually asymptomatic3
or present initially with bone pains,4
musculoskeletal pain, muscle weakness and hypocalcaemic tetany.
It is important to recognise that rickets can present not only in early childhood but also in late childhood with various clinical manifestations. Rickets may present atypically in adolescence with seizures. Screening of at risk immigrant families should be implemented through public health policies, and paediatricians should be aware that rickets is not just a disease of early childhood.
Nutritional rickets is re-emerging in western societies, particularly in young children and in adolescents of African or Asian descent. Hypocalcaemic fits resulting from vitamin D deficiency are rare in adolescents. It is likely that low dietary calcium led to rickets in the patient described here. This responds well to treatment with oral vitamin D.
- Hypocalcaemia can cause generalised tonic-clonic seizures.
- Vitamin D deficiency and dietary calcium deficiency are important causes of hypocalcaemia.
- Rickets can present with seizures secondary to hypocalcaemia.