A painful limp

Abstract

We describe a healthy 18-month-old child who developed a painful limp, without a history of trauma or fever. The initial laboratory investigations showed normal results but the radiological findings were suggestive of scurvy. Diagnosis was confirmed by blood tests and by a rapid recovery following replacement therapy.

Forensic Aspects of Pediatric Fractures

“…A growing fracture can also occur as complication after neurosurgery for corrective cranial vault reshaping [148].…”

“…In the nineties there were three case reports from France (1993), Italy (1992) and Spain (1991) [140][141][142]. In non-Western and non-or less industrialised countries, case reports and announcements on epidemics still surface regularly [143][144][145][146][147][148][149][150].…”

Childhood scurvy in a medieval burial from Mačvanska Mitrovica, Serbia

“…Onset of scurvy varies with physical indications usually appearing 6-12 months after vitamin C deficiency (Brickley & Ives, 2006;Narchi & Thomas, 2000). However, symptoms have been known to appear as early as 1-4 months after complete cessation of vitamin C intake (Tamura et al, 2000;Fain, 2005;Larralde et al, 2007).…”

Could Vitamin C deficiency have a role in shaken baby syndrome?

“…Subperiosteal hemorrhages and dysfunction of osteoblasts can cause skeletal changes in patients with scurvy 3 . The former can present with painful swellings of the ankles/knees or ‘pseudoparalysis’.…”

“…The costochondral junctions may be prominent, forming a rosary from subluxation of the sternum, unlike the ricketic rosary where the rib ends are expanded. Radiological changes in scurvy include: (i) characteristic dense line of provisional calcification at the metaphysis (Fraenkel's line); (ii) ground‐glass appearance of bone due to atrophic spongiosis; (iii) pencil outline or a ringed white margin of the epiphysis due to thickened peripheral shell of calcification; (iv) fissure and fractures; (v) lateral spurs; (vi) subperiosteal hemorrhages; and (vii) transverse band (scurvy line) of atrophic bone layer between the sclerotic provisional zone and the spongiosis in the shaft 3 . It is well recognized that scurvy is one of the differential diagnoses of the healing classical metaphyseal lesions in infants suffering from physical abuse 4 .…”