title: Severe rickets in a young girl caused by celiac disease: the tragedy of delayed diagnosis: a case report.
abstract: BACKGROUND
  Celiac disease is a systemic immune mediated disease which usually presents with gastrointestinal symptoms, but it may present with extra gastrointestinal manifestations such as metabolic bone disease and failure to thrive. This may lead to a delay in the diagnosis.
  
  
  METHODS
  We present a 13 year old female from the middle east with an 8 year history of severe rickets causing multiple bone deformities leaving the child crippled with bowing of both of her arms and legs. The patient was also found to have growth failure, anemia and on further workup she was found to have celiac disease.
  
  
  CONCLUSIONS
  We are presenting this case because it shows a severe case of rickets after malabsorption for many years. Celiac disease should be kept in mind as a cause of rickets in patients not responding to usual forms of treatment or when associated with other manifestations of malabsorption.
authors.affiliation: Department of Medicine, Sana'a University Medical School, Sana'a, Yemen. balsharafi@hotmail.com.
authors.forename: Butheinah A
authors.initials: BA
authors.lastname: Al-Sharafi
authors.forename: Shafiq A
authors.initials: SA
authors.lastname: Al-Imad
authors.forename: Amani M
authors.initials: AM
authors.lastname: Shamshair
authors.forename: Derhim H
authors.initials: DH
authors.lastname: Al-Faqeeh
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000150:complications*; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D012279:Rickets / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D012720:Severity of Illness Index