Rickets

Case contributed by Cesar Luceno

Presentation

Patient with milk allergy and poor diet presents with bilateral leg weakness, pain and reluctance to walk in the setting of hypocalcemia and no recent trauma.

Patient Data

Age: 3 years
Gender: Male
X-ray

Right and left upper extremities: Metaphyseal fraying and cupping are seen involving the distal radius, distal ulna, and proximal humerus.
  
Right and left lower extremities: Metaphyseal fraying and cupping are seen involving the distal tibia, as well as the proximal and distal tibia and fibula. Coxa valga is noted.

Case Discussion

It is important to note that although radiographic changes such as metaphyseal fraying, cupping and flaring are pathognomonic for rickets, acute changes are not observed during its early stages. 

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