Case of the Month – March 2018

By Dr Mark Ready

History

21 month old girl from Africa. Bowed Legs. Biochemistry confirms low Vitamin D.

Imaging

X-ray

Findings

METAPHYSEAL CHANGES
Sclerosis, splaying and beaking.

EPIPYSEAL CHANGES
Loss of dense outline.

GENU VARUS

Other X-ray changes one would expect to see, which are not present in this case are:

Periosteal reaction along diaphysis; Generalised demineralision; Coxa Vara; Cupping and widening rib ends – “rachitic rosary”; Scoliosis and biconcave vertebrae

Etiology

Vitamin D deficiency – dietary or decreased exposure to sunlight.

Vitamin D required for calcium absorption from gut and renal tubules

Regulates apoptosis of chondrocytes, cartilage matrix mineralisation and metaphyseal angiogenesis.

Differential Diagnosis

Leukemia, Metastatic neuroblastoma, non-accidental injury, bone dysplasia.

COM March2018