Case 118

Medical History

A 26-month old male patient from Jequitinhonha (MG, Brazil) was admitted with a history of convulsions and repeated respiratory infections. He was exclusively breast-fed until the age of six months and ever since his nutrition is based in fruits, legumes and leafy vegetables. Physical examination findings include hypoactivity, muscular hypotonia, costochondral swelling and double malleoli sign. He showed no muscular and joint pain during examination.

Image 1: Posteroanterior chest radiograph.


Image 2: Left wrist radiograph.


Image 3: Right knee radiograph.


Based on the clinical history and on the images provided, which is the most probable diagnosis?

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