A case of young patient presents to you with knee pain, irritability and gum bleeding. Upon x-ray of leg, cortex is significantly thin with a white line at the metaphysis. What could be possible cause:

Ans. (c) ScurvyRef: Maheshwari 5th ed. 1315Scurvy causes failure of collagen synthesis and osteoid formation. It clinically presents with:* Irritability* Gum bleeding* Pseudoparalysis (due to subperiosteal haemorrhage)* Anemia and beading of costo-chondral junction. Radiological features are: Frenkels line (dense line between metaphysic & physis/epiphysis), ring sign, thin cortex, scurvy line (band of rarefaction on the diaphyseal side) and metaphyseal osteopenia, cleft and fractures.Pathology: deficiency causes failure of collagen synthesis or primitive collagen formation, throughout the body, including in blood vessels, predisposing to haemorrhage.RICKETSSCURVY* Metaphysis: indistinct; frayed, splaying, and cupping of margin. Patchy sclerosis in case of intermittent dietary deficiency* Widened epiphysis with hazed cortical margin* Generalized reduction in bone density* Looser's zone (less common)* Severe cases show Genu valgum, bow legs, thoracic kyphosis, pigeon chest, ricketic rosary, skull bossing, cox vera.* Metaphysis: Frankel's white line, Trummerfeld, lucent zone, Pelkan spur due to fracture.* Wimberger's sign (small epiphysis surrounded by sclerotic rim)* Subperiosteal hemorrhage with periosteal elevation* Ground glass appearance of bone with pencil thin cortex.