A Girl with Limping and Leg Pain

Examination was notable for tenderness to palpation of bilateral distal femurs and proximal tibiae, painful limitation of knee flexion, and an antalgic gait. Levels of C-reactive protein and erythrocyte sedimentation rate were 6.9 mg/l (reference range, <5) and 36 mm/hour (reference range <15), respectively. Plain radiography showed sclerosis in the distal femoral metaphysis (Figure 1), and MRI demonstrated multifocal symmetric marrow and soft-tissue edema. A dietary history revealed low intake of fruits and vegetables, leading to targeted testing for and the diagnosis of scurvy.