A 9-month-old baby boy was admitted to the hospital with symptoms of irritability, low-grade fever, and pain in the legs, which had begun eight months previously but had progressed to complete immobility. The baby had been fed for weeks with only sterilized cow's milk and biscuits. He had not been given fresh fruits or vitamin supplement.
On physical examination, he lay in the "frog" position and swellings of both lower limbs, including both knees were evident. Any touching of the legs was very painful. A "rosary" was present at the costochondral junctions. There was swelling and purpuric discoloration of the gums. He was anemic. The RBC count was 3,260,000/cu mm and the hemoglobin value was 6.8 g/dL. White blood cell and platelet counts were normal. There was increased capillary fragility. Urinalysis showed microscopic hematuria and mild proteinuria. Roentgenograms of the lower legs, including knees, were obtained (Fig 1). Twenty