Rickets in a white adolescent.

Case report A 15-year-old Caucasian male presented with a 2-year history of pain in both knees aggravated by exercise. His diet consisted of chips, bread, sweets and fizzy drinks, while he refused to eat meat, fish, fruit or fresh vegetables because they made him 'feel sick'. He was drinking milk and taking margarine on bread, however, and dietary assessment showed a normal vitamin D and calcium intake. Ultraviolet exposure had been adequate but since developing bone pains he had tended to remain indoors. He was tall for his age (1.73 m) having had a rapid growth spurt when 12 years old although he had not grown over the previous 2-3 years. At the age of 12 years his height would have been outside the 97th centile and when first seen he was the tallest boy in his class. There was no significant past medical history, and clinical examination was normal.