Chronic Non-infectious Osteomyelitis Mimicking Scurvy as the Presenting Sign of Crohn’s Disease: Case Report

Goldfarb, Alexa; Breitling, Stefan; Amadasun, Owen; Kiernan, Bridget; Simson, Gabrielle Gold‐von; Sagalowsky, Selin Tuysuzoglu

doi:10.3389/fped.2022.871993

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…The diagnosis of scurvy in patients with concomitant GI issues, such as inflammatory bowel disease (IBD) or CD, has been observed to be difficult. A case report revealed a pediatric patient who presented with symptoms suggestive of scurvy to later be diagnosed with persistent non-infectious osteomyelitis, which was the patient’s first presenting symptom of CD [ 5 ]. Another case report described a patient with perifollicular petechiae of the limbs, a severe lower extremity hematoma, and sacral osteopenia who was misdiagnosed with leukocytoclastic vasculitis on multiple occasions [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Vitamin C Deficiency Masquerading as Vasculitis in a Patient With Crohn’s Disease

Verma,

Deligonul,

Chen

et al. 2024

Cureus

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This case study features a 40-year-old male with Crohn's disease (CD) who was initially misdiagnosed with vasculitis but was later shown to have scurvy owing to vitamin C deficiency. The patient's diet was nearly exclusively made up of highly processed fast food, with no fresh fruits or vegetables. A mildly sensitive, violaceous rash on his lower legs, mild gingival hemorrhage and enlargement, and muscle soreness were among his symptoms. Anemia and undetectable vitamin C levels were discovered in laboratory studies. A skin sample revealed follicular hyperkeratosis, coiled hairs, and perifollicular bleeding, eliminating the possibility of vasculitis. Scurvy was confirmed by undetectable vitamin C levels and intramuscular bleeding discovered during a muscle biopsy. After one month of vitamin C administration, the patient's skin was entirely clear. This instance emphasizes the significance of taking vitamin C insufficiency into account in patients with CD and other disorders that can cause malabsorption. Misdiagnosis might result in unneeded treatments and medical expenses. Scurvy must be diagnosed as soon as possible because it might cause gastrointestinal/intracerebral hemorrhage and death.

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Section: Discussionmentioning

confidence: 99%

Vitamin C Deficiency Masquerading as Vasculitis in a Patient With Crohn’s Disease

Verma,

Deligonul,

Chen

et al. 2024

Cureus

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“…Other manifestations include loss of appetite, low-grade fever, anemia of a variable degree, tendency to bruise or bleed easily at any site, petechial hemorrhages, poor wound healing, and dry rough skin [6][7][8]. Numerous risk factors that contribute to scurvy have been identified, predominantly relating to malnutrition, including eating disorders, drug and alcohol dependence, inflammatory bowel disease, and socioeconomic deprivation [1,3,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis Mimicking Scurvy in a Child: A Case Report

Alhalabi¹,

Nasrallah²,

Rahman³

et al. 2023

Cureus

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Scurvy is a rare clinical syndrome resulting from prolonged vitamin C deficiency and is uncommon in the Gulf area. It can present with non-specific symptoms, making diagnosis and treatment challenging. In pediatric patients, symptoms may include weight loss, lethargy, low-grade fever, anemia of varying degrees, easy bruising or bleeding, joint and muscle pain, and poor wound healing. Despite advances in healthcare in many Gulf countries, nutritional deficiencies can still occur in certain populations. Therefore, it is important for pediatricians, orthopedists, rheumatologists, and radiologists to consider scurvy in the evaluation of children with low-grade, multisystemic involvement. We report a case of a six-year-old boy who presented to the emergency department (ED) multiple times with progressive right (RT) leg pain. The clinical picture and imaging findings suggested chronic recurrent multifocal osteomyelitis (CRMO). Despite symptom progression, scurvy was ultimately diagnosed and treatment with vitamin C led to rapid resolution of his symptoms. This case highlights the importance of considering scurvy in the differential diagnosis of children with multisystemic involvement, especially in regions where nutritional deficiencies may be more prevalent.

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Chronic Nonbacterial Osteomyelitis in Inflammatory Bowel Disease

Tzaneti,

Athanasopoulou,

Fessatou

et al. 2023

Life

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Chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), is a rare autoinflammatory bone disease primarily affecting children and adolescents. This review presents a comprehensive analysis of the intricate relationship between CNO and inflammatory bowel disease (IBD), shedding light on shared pathophysiological mechanisms and clinical management. A thorough literature review was conducted, encompassing 24 case reports involving 40 patients. The demographic distribution of patients revealed a near-equal gender ratio, with a median age of diagnosis at 12 years. The diagnosis patterns showed a higher proportion of CNO as the initial diagnosis, while Crohn’s disease was more prevalent than ulcerative colitis. The time interval between the clinical presentations varied, ranging from simultaneous detection to a substantial 15-year gap. Treatment modalities included nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, aminosalicylates, and biologic agents, such as infliximab, often overlapping in their use and suggesting shared pathophysiological pathways. Both conditions displayed systemic manifestations, and patients often responded well to immunosuppressive medications. The pathophysiology of CNO involves a genetic predisposition, cytokine dysregulation, and osteoclast activation. Dysregulated innate immunity results in immune cell infiltration into bones, causing sterile bone lesions. Notably, emerging evidence hints at a potential link between the microbiome and CNO. In contrast, IBD results from imbalanced mucosal immune responses to the intestinal microbiota. Polymorphisms in the promotor region of IL-10, common cytokines, immune cells, and genetic markers indicate shared immunological and genetic factors between CNO and IBD. Both conditions also involve extraintestinal symptoms. This analysis underscores the need for clinical awareness of the co-occurrence of CNO and IBD, especially among pediatric patients. A deepened understanding of the connections between these seemingly distinct diseases could lead to more effective management and improved patient outcomes.

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Chronic Non-infectious Osteomyelitis Mimicking Scurvy as the Presenting Sign of Crohn’s Disease: Case Report

Cited by 3 publications

References 33 publications

Vitamin C Deficiency Masquerading as Vasculitis in a Patient With Crohn’s Disease

Vitamin C Deficiency Masquerading as Vasculitis in a Patient With Crohn’s Disease

Chronic Recurrent Multifocal Osteomyelitis Mimicking Scurvy in a Child: A Case Report

Chronic Nonbacterial Osteomyelitis in Inflammatory Bowel Disease

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