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Sunil Taneja, Rakhi Jain, Gulnaz Nadri, Shailendra Singh Rathore
Madhuraj Hospital, Kanpur, India
Address for Correspondence: Dr. Rakhi Jain, 98,Y1,Kidwai Nagar, Kanpur, India. Email: email@example.com
A one and a half month old male child presented with irritability and localized swelling over both lower limbs for one week, discovered by the mother while oil massage. There was no history of fever and trauma. The child was born at term by normal delivery.
Immunization was complete for age and the baby was exclusively breast fed. There was no history of intake of vitamin supplements. There was no similar history in the parents or sibling nor was there any social problem in the family. On examination, the child
was irritable. There was no dysmorphism. Weight, length and head circumference were 4.6 kg, 59 cm and 37.5 cm respectively which were normal for age. There was firm swelling over the medial surface of tibia on both lower limbs which was tender to touch. There
was no other swelling over rest of the body. Systemic examination was normal. Investigations showed hemoglobin 11.7gm/dl, total leucocyte count 8400 cells/cumm, platelet count 2,75,000 cells/cumm, ESR 12mm at end of 1 hour, serum calcium 7.8 mg/dl, phosphorus
2mmol/l and alkaline phosphatase 469 IU/L. VDRL of mother was negative. X ray of both lower limbs showed periosteal reaction and sclerotic changes of both tibial bones but there were no osteolytic changes. X ray skull and mandible were normal. MRI of leg showed
mild periosteal elevation.
What is the diagnosis_?