Symmetrical involvement of bones at similar sites in both lower limbs suggests likelihood of metabolic disease. Patient was a known case of hereditary fructose intolerance and did not consume any fruits for years. Serum vitamin C was low and supplementation alleviated patients symptoms confirming the diagnosis of scurvy.

Differential in such multifocal involvement would include chronic recurrent multifocal osteomyelitis (CRMO), however, less likely due to symmetrical involvement.