Osteopenia caused by acute lymphocytic leukemia

A 2-year-old boy presented with extremity pain and refused to walk. Radiographs of the tibia (A) and AP (B) and lateral (C) views of the feet show mottled osteopenia in the metaphysis with areas of cortical destruction. The distribution was symmetric and involved all extremities. Distribution does not fit migratory osteoporosis. The diagnosis was acute lymphocytic leukemia.