Osteomalacia and rickets Quiz: Ace Your Exams

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A 10-month-old girl is brought to the pediatrician by her parents because of poor growth. The patient was born at 38-weeks gestational age via an uncomplicated vaginal delivery. The patient is exclusively breast fed, does not consume formula, and spends most of her time indoors. Past medical history is notable for a viral upper respiratory tract infection at 7-months-old. Family history is notable for Celiac disease in her older brother. The patient is below the 10th percentile for height and weight. Physical examination reveals bowing of the legs. Skeletal imaging is ordered, and results similar to those shown below are found:

A chest X-ray of an infant shows bilateral perihilar infiltrates, more pronounced on the right, with diffuse reticulogranular opacities in both lung fields.
Reproduced from: Wikimedia Commons

Which of the following is the most likely cause of the patient’s presentation?

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