Question

X-ray of a 5 year old child is shown in the image. Bone mineral density is normal. Identify the condition.

• A. Rickets
• B. Scurvy
• C. Metaphyseal dysplasia
• D. Osteopetrosis

Hint:

Normal bone mineral density with subperiosteal haemorrhage and Wimberger ring on X-ray points to a vitamin deficiency disease.

Answer 1

The Correct Option is B

Answer: Scurvy (Vitamin C deficiency)

Key radiological signs of scurvy (mnemonic: WPTS):
- Wimberger ring: ring of calcification around epiphysis
- Pelken spur: spike at lateral corner of metaphysis
- Trummerfeldzone: lucent band (zone of destruction) proximal to Frankel line
- Subperiosteal haemorrhage: elevated periosteum due to capillary fragility
- White line of Frankel: dense band at the metaphysis (zone of provisional calcification)

Why BMD is normal in scurvy but reduced in rickets:
- Scurvy: defective collagen (Vit C needed for hydroxylation of proline/lysine) -- mineralisation intact, BMD normal
- Rickets: defective mineralisation (Vit D deficiency) -- BMD reduced

Age group: Scurvy in infants 6-24 months; manifests as irritability, pseudoparalysis, perifollicular haemorrhage, gum bleeding.

\[\boxed{\text{Scurvy}}\]