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What is A six month old infant fed totally on cow's milk has been brought with bleeding spots, anaemia, fever and generalised tenderness. On examination, there were swelling in both the lower extremities and the blood count was normal. The most likely diagnosis is – and explain in detail?
Exclusive feeding on Cow's milk in a 6 months infant with anemia, bleeding, fever and generalized tenderness suggest the diagnosis of scurvy.
Cow's milk does not contain sufficient amount of Vitamin C. On the other hand breast milk contains sufficient Vitamin C.
Clinical manifestations of scurvy 

The usual age of manifestations of scurvy is 6-18 months.
The manifestions are -


General symptoms -f Low grade fever, irritability, tachypnea, digestive disturbances, loss of appetite.
Bleeding --> Subperiosteal, gingival and conjuctival hemorrhage, purpura & ecchymoses, petechiae, perifollicular hemorrhage, epistaxis.
Defective dentition —> Bluish purple, spongy swellings of mucous membrane (due to hemorrhage), especially over the upper incisors.
Generalized tenderness and pseudoparalysis --> child is difficult to handle due to pain and generalized tenderness. The pain results in pseudoparalysis with the hips and knees in semi-flexed position and the feet rotated externally.
Scorbutic rosary --> Due to epiphyseal sepration, costochondral junction is disrupted and sternum is displaced backward with attached costal cartilages. The end of ribs becomes prominent —> rosary.
Anemia Due to defect in utilization of iron & folic acid.
Bones are brittle and easily fractured.
Irritability and other psychologic symptoms.
Others —f Arthralgia, muscle weakness, degenration of skeletal muscles, cardiac hypertrophy, adrenal atrophy and bone marrow depletion.

Differences between rachitic and scorbutic rosary
Rachitic Rosary                                                                Scorbutic Rosary

Due to metaphyseal widening                                   o Due to epiphyseal separation
Non-tender                                                                    o Tender
Rounded                                                                       o Angular


Remember

Vitamin C is not stored in the body, but is taken up by all tissues, the highest levels are found in the pituitary and adrenal glands.