Infantile scurvy: Still a relevant differential diagnosis in Western medicine

Schwetje, Desirée; Zillekens, Anne; Kieback, Jan-Dirk; Koob, Sebastian; Placzek, Richard

doi:10.1016/j.nut.2020.110726

Cited by 7 publications

(11 citation statements)

References 15 publications

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“…Although considered a rare disease in high income countries, scurvy has been recently increasingly reported in children [ 55 ]. In literature, the large majority of children with scurvy are reported to have underlying conditions leading to inadequate nutrition such as neuropsychiatric [ 14 , 56 , 57 ] or neurological and developmental disorders [ 3 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, classic findings develop at the distal ends of the long bones and are usually present at the knees and ankles; however, the pelvis and sacroiliac bone can also be also affected. The most specific radiographic features include Fränkel’s line, an irregular but thickened white line in the metaphyseal endings, representing the zone of well-calcified cartilage and an adjacent Trummerfeld zone, a rarefaction secondary to poorly formed trabeculae [ 55 , 70 ]. In addition, the Pelkan spur represents a healing metaphyseal pathological fracture and the Wimberger ring sign denotes a thin sclerotic rim surrounding a small lucent epiphysis [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

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A Narrative Review on Pediatric Scurvy: The Last Twenty Years

et al. 2022

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Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. We performed an extensive review of the literature analyzing studies published in the last 20 years focusing on clinical features, differential diagnosis and diagnostic delay. Fifteen articles were selected, collectively reporting a total of 166 children. Because of the wide clinical spectrum (musculoskeletal complaints and/or mucocutaneous lesions or systemic symptoms), scurvy can mimic several conditions, including autoimmune diseases, infections, and neoplasia. In addition, frequent findings such as normal nutritional status, anemia or elevated inflammatory markers may guide clinicians towards the abovementioned misdiagnoses. Scurvy should be considered in patients presenting with musculoskeletal complaints, not only in those with risk factors but also in healthy children. A focused dietary history and a careful physical examination, assessing other signs of vitamin C deficiency, are mandatory in these patients. When suspected, the dosage of serum vitamin C is the diagnostic gold standard; furthermore, imaging studies, performed by an expert radiologist, can reveal the typical features of scurvy. Only early diagnosis can avoid unnecessary investigations and potentially fatal complications of the disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Narrative Review on Pediatric Scurvy: The Last Twenty Years

et al. 2022

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“…Microcytic anemia and elevation of inflammatory markers are common laboratory findings, as seen in our patients in which all but one had microcytic anemia and all had elevated inflammatory markers, especially ESR with slightly altered CRP. Anemia may be secondary to a combination of bleeding and decreased iron absorption, or abnormal folate metabolism (5,(39)(40)(41). Indeed, folate levels should be checked in patients with scurvy, regardless of hemoglobin and mean corpuscular volume values.…”

Section: Discussionmentioning

confidence: 99%

When the limp has a dietary cause: A retrospective study on scurvy in a tertiary Italian pediatric hospital

et al. 2022

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The limping child frequently represents a diagnostic challenge. The differential diagnosis is broad and should include vitamin C deficiency. Scurvy, resulting from vitamin C deficiency, is the oldest-known nutritional disorder. Despite its rarity in developed countries, scurvy has been increasingly reported in recent years in pediatric patients, particularly those with autism or neurological disabilities. In the present retrospective study, we describe the clinical, laboratory, and radiological features of 8 patients diagnosed with scurvy in the Pediatrics Unit of Meyer Children's University Hospital, between January 2016 and December 2021. The majority (87%) were males, and the median age was 3.7 years. Half of the patients had comorbidities known to be risk factors for scurvy, while the remaining patients were previously healthy. All the children were admitted for musculoskeletal symptoms, ranging from lower limb pain (87%) to overt limping (87%). Mucocutaneous involvement was observed in 75% cases. Microcytic anemia and elevated inflammatory markers were common laboratory findings. Bone radiographs, performed on all patients, were often interpreted as normal at first, with osteopenia (62%) as the most frequent finding; notably, after re-examination, they were reported as consistent with scurvy in four patients. The most common magnetic resonance imaging findings were multifocal symmetrical increased signal on STIR sequence within metaphysis, with varying degrees of bone marrow enhancement, adjacent periosteal elevation and soft tissue swelling. Differential diagnosis was challenging and frequently required invasive diagnostic procedures like bone marrow biopsy, performed in the first three patients of our series. The median time frame between clinical onset and the final diagnosis was 35 days. Notably, the interval times between admission and diagnosis become progressively shorter during the study period, ranging from 44 to 2 days. Treatment with oral vitamin C led to improvement/resolution of symptoms in all cases. In conclusion, scurvy should be considered in the differential diagnosis in a limping child, performing a detailed dietary history and careful physical examination, looking for mucocutaneous lesions. A quick and correct diagnostic path avoids invasive diagnostic procedures and reduces the risk of long-term complications.

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“…Scurvy, although considered a rare disease in developed countries, is currently reemerging in children. 2 Most of children with scurvy present neuropsychiatric or developmental disorders, predisposing to dietary restrictions. 3,4 Other conditions can reduce vitamin C absorption (celiac, Crohn disease) and/or increase its requirement (hemodialysis, bone marrow transplant, chemotherapy).…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous or inadequately healing fractures can be due to scurvy because of the enhanced bone reabsorption and defective osteoid matrix. 2,3 Other rare and potentially lethal manifestations include cardiac hypertrophy, pulmonary hypertension, diminished adrenal and bone marrow function, poor postoperative wound healing, cerebral hemorrhage, and hemopericardium. 10 Diagnosis of scurvy is challenging because of several factors, besides its rarity.…”

Section: Discussionmentioning

confidence: 99%

The Pitfall in Differential Diagnosis of Musculoskeletal Symptoms in Children

et al. 2020

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S curvy is a well-known disorder caused by vitamin C deficiency. Its clinical spectrum is quite variable and can mimic several infectious, inflammatory, or oncological conditions. These factors contribute to frequent misdiagnosis of scurvy in pediatric age. Patients often require medical attention for musculoskeletal symptoms and undergo an extensive workup before final diagnosis. In the present case series, we describe 4 children diagnosed with scurvy in the

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Infantile scurvy: Still a relevant differential diagnosis in Western medicine

Cited by 7 publications

References 15 publications

A Narrative Review on Pediatric Scurvy: The Last Twenty Years

A Narrative Review on Pediatric Scurvy: The Last Twenty Years

When the limp has a dietary cause: A retrospective study on scurvy in a tertiary Italian pediatric hospital

The Pitfall in Differential Diagnosis of Musculoskeletal Symptoms in Children

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