Scurvy presenting primarily as gingival manifestation in a young child: a diagnostic dilemma

Abstract

Vitamin C deficiency, historically known as scurvy, was associated with sailors in the Victorian times, however, a global review in 2020 suggests it still exists in certain at-risk groups.A case is presented of a young non-verbal child with learning difficulties and on a restricted diet, in which the primary symptom was gingival inflammation. It posed a diagnostic dilemma due to the non-specific symptoms, and a delay in the diagnosis, until vitamin C deficiency was confirmed.Gingival inflammation is one of the common findings in vitamin C deficiency and dental professionals may be the first point of contact. The importance of dietary evaluation, identifying and looking for other signs and liaising with the medical colleagues are discussed.This case highlights the role of the dentist in identifying latent cases of vitamin C deficiency and to consider this as a differential diagnosis especially in certain at-risk groups.

Scurvy masquerading as IgA vasculitis

“…Although rare in modern times, case reports confirm that children with selective diets secondary to developmental disabilities, feeding difficulties, autism spectrum disorder and eating disorders [ 4 ] may be at risk of developing scurvy . Children in poor living conditions with limited access to fresh fruits and vegetables and infants fed purely on unfortified cow’s milk are also at risk [ 4 , 10 , 17 , 18 ]. It is important to remember that scurvy also occurs in developmentally healthy and chronic illness-free children that gradually develop a self-restraint towards vitamin C-rich foods [ 19 ].…”