Presentation
Right knee pain and swelling. No history of trauma.
Patient Data
The distal femoral physis is abnormal and widened. There are similar appearances of the proximal tibial physis also. In addition, there are abnormal lucent lines in the metaphyses paralleling the physis.
There is abnormal periosteal reaction along the posterior aspect of the distal femur on the lateral view.
In the correct clinical context, hypovitaminosis C would be a possible diagnosis.
Case Discussion
Following the x-ray and discussion of possible vitamin deficiency, parents disclosed an exceptionally limited diet. Vitamin C level was checked and was <1 mmol/l confirming the diagnosis.
Symptoms resolved with vitamin C supplementation.
Scurvy is not an uncommon diagnosis even in developed nations. Restricted diets of children with autistic spectrum disorder (or for other reasons) is a risk factor.
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