{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T10:35:01Z","timestamp":1766399701396,"version":"3.48.0"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Vitamin D\u2010dependent rickets type II (VDDR\u2010II) is a rare hereditary disorder caused by mutations in the vitamin D receptor gene, resulting in resistance to active vitamin D and impaired calcium absorption. We report a 2\u2010year and 6\u2010month\u2010old female toddler presenting with persistent rickets, delayed motor milestones, dental abnormalities, and recurrent hypocalcemia despite standard vitamin D and calcium supplementation. Initial assessment of nutritional rickets was reconsidered due to the development of pathological fractures and persistent biochemical abnormalities\u2014including hypocalcemia, elevated parathyroid hormone, high bone\u2010specific alkaline phosphatase, and markedly elevated 1,25\u2010dihydroxyvitamin D\n                    <jats:sub>3<\/jats:sub>\n                    . The patient was managed with high\u2010dose calcitriol and calcium, resulting in gradual clinical and biochemical improvement. This case emphasizes the importance of recognizing red flags for genetic rickets in children unresponsive to conventional therapy and demonstrates the utility of integrated clinical, radiographic, and biochemical evaluation for early diagnosis, particularly in resource\u2010limited settings where molecular testing may not be available.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.71696","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:18:01Z","timestamp":1766143081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Nutritional Deficiency: Persistent Rickets as a Manifestation of Vitamin D\u2010Dependent Rickets Type\n                    <scp>II<\/scp>\n                    in a Toddler"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3855-450X","authenticated-orcid":false,"given":"Abhisek","family":"Jha","sequence":"first","affiliation":[{"name":"Department of Endocrinology Birat Medical College Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anil","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Birat Medical College Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uma Shankar","family":"Jha","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Birat Medical College Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Preethuja","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Birat Medical College Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohan Kumar","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Birat Medical College Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuldeep","family":"Timilsina","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Birat Medical College Teaching Hospital  Morang Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prabha","family":"Jha","sequence":"additional","affiliation":[{"name":"School of Medical Sciences Kathmandu University  Dhulikhel Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aabish","family":"Dahal","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Birat Medical College Teaching Hospital  Morang 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