Scurvy Presenting as Painful Gait With Bruising in a Young Boy

Tamura, Yoshiko; Welch, Derek C.; Zic, John A.; Stein, Sharon M.; Hummell, Donna S.

doi:10.1001/archpedi.154.7.732

Cited by 66 publications

(51 citation statements)

References 13 publications

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“…Ascorbic acid improves iron absorption by reducing it to the more absorbable ferrous state, 11 and in our patient, who had absent bone marrow iron stores, the anemia only improved after vitamin C administration, despite 6 weeks of previous iron supplementation. Although nonspecific, an elevated erythrocyte sedimentation rate and C-reactive protein may be seen, 5,10 which most likely reflects the inflammation involved in the bone and gingiva as was seen on biopsy in our patient. Other clinical signs of scurvy include skeletal muscle degeneration, cardiac hypertrophy, diminished adrenal and bone marrow function, psychological changes, arthritis, poor wound healing, edema, and alopecia.…”

Section: Discussionmentioning

confidence: 55%

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An Orange a Day Keeps the Doctor Away: Scurvy in the Year 2000

Weinstein¹,

Babyn

Zlotkin³

2001

Pediatrics

237

278

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ABSTRACT. Scurvy has been known since ancient times, but the discovery of the link between the dietary deficiency of ascorbic acid and scurvy has dramatically reduced its incidence over the past half-century. Sporadic reports of scurvy still occur, primarily in elderly, isolated individuals with alcoholism. The incidence of scurvy in the pediatric population is very uncommon, and it is usually seen in children with severely restricted diets attributable to psychiatric or developmental problems. The condition is characterized by perifollicular petechiae and bruising, gingival inflammation and bleeding, and, in children, bone disease. We describe a case of scurvy in a 9-year-old developmentally delayed girl who had a diet markedly deficient in vitamin C resulting from extremely limited food preferences. She presented with debilitating bone pain, inflammatory gingival disease, perifollicular hyperkeratosis, and purpura. Severe hypertension without another apparent secondary cause was also present, which has been previously undescribed. The signs of scurvy and hypertension resolved after treatment with vitamin C. The diagnosis of scurvy is made on clinical and radiographic grounds, and may be supported by finding reduced levels of vitamin C in serum or buffy-coat leukocytes. The response to vitamin C is dramatic. Clinicians should be aware of this potentially fatal but easily curable condition that is still occasionally encountered among children. Pediatrics 2001; 108(3). URL: http://www.pediatrics.org/cgi/content/full/ 108/3/e55; scurvy, hypertension, magnetic resonance imaging, bone pain. ABBREVIATION. MRI, magnetic resonance imaging.A 9-year-old girl with global developmental delay presented with signs of scurvy secondary to long-term ascorbic acid deficiency and was also discovered to have severe hypertension. This case highlights a rare disease that still exists in the pediatric population and points to a possible association between hypertension and vitamin C deficiency. Magnetic resonance imaging (MRI) findings of scurvy, which have been previously unreported, are described. CASE REPORTA 9-year-old girl was admitted to hospital because of musculoskeletal pain, inflammatory gingival disease, and hypertension.Her past medical history was remarkable for moderate global developmental delay, mild facial dysmorphism, and a seizure disorder managed with long-term phenytoin administration. She had 2 older sisters with a similar disorder, and a previous evaluation had not identified a known, inherited condition.She was admitted to a community hospital with a 2-month history of increasing bilateral knee pain and swollen, bleeding gums. There was no history of fever, weight loss, trauma, obviously swollen joints, petechiae, or bruising. At the time of her hospitalization, the child refused to walk. She previously ambulated with the aid of a walker.Investigations at that time revealed a hemoglobin of 79 g/L, white blood cell count of 8.9 ϫ 10 9 /L with a normal differential count and a platelet count of 470 ϫ 10 9 /L. A ...

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Section: Discussionmentioning

confidence: 55%

“…Scurvy is less common in the pediatric population, but case reports still appear. 5,6 Groups at risk include infants who are fed evaporated or boiled milk, in which ascorbic acid is destroyed by heat and children with dietary restrictions stemming from psychiatric or developmental disorders, such as the child described here.…”

Section: Discussionmentioning

confidence: 99%

An Orange a Day Keeps the Doctor Away: Scurvy in the Year 2000

Weinstein¹,

Babyn

Zlotkin³

2001

Pediatrics

237

278

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“…Serum alkaline phosphatase is low in severe zinc deficiency and returns to normal after treatment. 22,23 We did not order zinc levels in neutrophils and lymphocytes.…”

Section: Discussionmentioning

confidence: 96%

“…23 Hemorrhagic manifestations and poor wound healing are evident symptoms after 3 to 6 months of decreased dietary intakes of vitamin C. 9 Humans are unable to synthesize vitamin C and thus depend on external sources to fulfill these requirements. 8 The usual sources of vitamin C include raw fresh fruits and vegetables.…”

Section: Discussionmentioning

confidence: 99%

Scurvy Is Still Present in Developed Countries

et al. 2008

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“…A circular, opaque radiological shadow often surrounds epiphyseal centers of ossification. This ring of increased opacity formed around the ossification center of long bone epiphyses is known as the Wimberger sign, which may result from bleeding or attachment movement (14,15,16). The goal of treatment of scurvy is to saturate the body rapidly with ascorbic acid.…”

Section: Open Accessmentioning

confidence: 99%

Osteoskeletal Manifestation of Scurvy in a Male Infant (Case Report)

Pop‐Jordanova¹,

Slavevska²,

Fustic³

2008

Macedonian Journal of Medical Sciences

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Scurvy, a disease of dietary deficiency of vitamin C, was uncommon in the last century due to improved nutrition and health care. However, in the last decade it was increasingly reported in adult population. In a period of infancy, scurvy appears after the age of five months and is related mainly to malnutrition. The main symptoms are vascular purpura, bleeding and gum abnormalities, but musculoskeletal manifestations could also be prominent. Children experience severe lower limb pain related to subperiosteal bleeding. The misdiagnosis with rickets and arthritis is common. We present a case of scurvy in 8 month boy with osteoskeletal manifestation, very rare seen in contemporary European pediatrics. The diagnosis of our patient is made by clinical presentation (such as haematuria, edema of lower extremities as well as swollen right leg), some biochemical parameters and radiological finding. The therapeutically outcome and follow-up of the boy confirmed the diagnosis and etiology.

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Scurvy Presenting as Painful Gait With Bruising in a Young Boy

Cited by 66 publications

References 13 publications

An Orange a Day Keeps the Doctor Away: Scurvy in the Year 2000

An Orange a Day Keeps the Doctor Away: Scurvy in the Year 2000

Scurvy Is Still Present in Developed Countries

Osteoskeletal Manifestation of Scurvy in a Male Infant (Case Report)

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