Key wordsbreast-feeding, Japan, sunlight exposure, vitamin D deficiency rickets, vitamin D supplementation.Recent research in rickets in Japan has focused on hereditary rickets, that is, X-linked hypophosphatemic vitamin D resistant rickets 1 or vitamin D-dependent rickets. 2 It was speculated that the advent of vitamin D-fortified milk and enhanced sunlight exposure decreased the previously common incidence of vitamin D deficiency rickets. However, vitamin D deficiency rickets continues to be reported in USA due to dietary restrictions without the benefit of adequate sunlight exposure or vitamin D supplementation and/or prolonged breast-feeding in dark-skinned infants. 3 Vitamin D levels in human milk (approximately 4.5 IU/dL) are generally low in comparison with vitamin D-fortified milk (about 50 IU/dL). 4 Therefore, a uniform policy of vitamin D supplementation has recently been recommended for breastfed infants in the USA. 3 Nineteen patients of vitamin D deficiency rickets due to dietary restrictions and/or lack of sunlight exposure between 1995 and 2000 were reported in Japan. [5][6][7][8][9][10][11][12] We describe one case of vitamin D deficiency rickets in Tochigi, not due to dietary restriction, and review recent reports written in English on vitamin D deficiency rickets in Japan. [5][6][7][8][9][10][11][12]
A 5‐year‐old Japanese boy developed concurrent poststreptococcal acute glomerulonephritk (PSAGN) and Schonlein‐Henoch purpura (SHP). An elevated titer of ASK on admission confiied the preceding streptococcal infection. Arthritis of the left knee and petechiae on admission were regarded as features of SHP. The presence of SHP was further confiied by the pathological fmding of leukocytoclastic vasculitk in the skin. PSACN was strongly suspected due to the sndings of microscopic hematuria and hypocomplementemia in the acute phase. The concwrence of SHP and PSAGN suggests similar underlying pathophys iological processes as poststreptococcal sequelae. At the height of the illness, peripheral blood lymphocyte subset analysis showed a marked increase in the suppressor inducer T subset and a reciprocal decrease in the helper T subset. lhis alteration in T lymphocyte subsets was regarded as indicative of the immunological derangement in this patient.
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