Presentation
Pain in left knee, past history of pin at multiple other locations.
Patient Data
Marrow edema is seen in bilateral distal femoral metaphysis, proximal tibial, fibular metaphyses, extending to tibial, fibular epiphyses. Mild surrounding periosteal and soft tissue edema is seen, more predominantly along medial aspects of distal left femur.
Marrow edema is also seen in bilateral distal tibial and fibular metaphyses(around ankle joint).
Mild irregularity and widening of visualized growth plates of both distal femurs, proximal, distal tibia and fibula.
Case Discussion
Symmetrical involvement of bones at similar sites in both lower limbs suggests likelihood of metabolic disease. Patient was a known case of hereditary fructose intolerance and did not consume any fruits for years. Serum vitamin C was low and supplementation alleviated patients symptoms confirming the diagnosis of scurvy.
Differential in such multifocal involvement would include chronic recurrent multifocal osteomyelitis (CRMO), however, less likely due to symmetrical involvement.