You volunteered to be part of a ‘healthcare for homeless’ drive for homeless people in your neighborhood. You come across a 76 year-old male who reports toothache and generalized fatigue for many months now. He is a chronic alcoholic and eats biscuits soaked in water most of the days. You noticed poor dentition with absent and loosened teeth. His gums are swollen, purple, spongy and bleeds easily. He has a depressed sternum with elevation at rib margins. His left knee joint is swollen and tender with reduced range of motion. He has petechiae and ecchymoses on both lower extremities. His skin has follicular hyperkeratosis and perifollicular hemorrhages with corkscrew-like hair. Laboratory tests are significant for normochromic, normocytic anemia, normal prothrombin time, and normal activated partial thromboplastin time. Radiographs of left lower knee joint showed diffuse osteoporosis of the lower end of left femur, subperiosteal hemorrhage, calcification of the elevated periosteum, thinning and brightness of cortices at the epiphyses of the knee. What is the most likely diagnosis in this patient?
