Picture of the Month

Abstract

A 15-MONTH-OLD boy had a history of unexplained bleeding from his gums for several weeks and fever for 2 days. He had been fed only cow's milk and oatmeal since age 4 months. On physical examination he had almost no spontaneous movement. His legs were held in a "frog leg" position (Figure 1), were swollen along the long bones, and were tender to palpation. His skin was dry and pale. Hemorrhages of the gingiva were obvious as were 2 blood-filled cysts of the lower ca-nine teeth (Figure 2). The tympanic membranes were hyperemic, and evidence of middle-ear fluid was present. Palpable prominence of the costochondral junctions of the chest wall was noted.The results of laboratory examinations revealed a normal white blood cell count, a hemoglobin level of 76 g/L, and a platelet count of 334ϫ10 9 /L. The serum calcium, phosphorous, copper, and alkaline phosphatase levels were normal. Thyroid stimulating hormone, triiodothyronine, and thyroxine levels were also normal. The serum level of vitamin D was normal, but vitamin C levels were low, 28 µmol/L (reference range, 45-108 µmol/L). Chest x-ray film showed a scorbutic rosary at the costochondral junctions with a "corner" sign noted in the proximal metaphysis of the humerus. Lower extremity radiographs demonstrated abnormalities (Figure 3).

An Unusual Presentation of a Child with Scurvy: A Case Report

“…Pseudoparalysis may become apparent due to bone pain. 5 The dominant features of this patient were joint pain and inability to walk without visible joint swelling.…”

“…Scurvy being a rare disorder usually missed by physician leading to a delayed diagnosis. 4,5 Initial manifestations of scurvy are vague like irritability, lack of appetite. 5 As it progresses, there will be generalized tenderness especially over long bones due to subperiosteal hemorrhage.…”

“…4,5 Initial manifestations of scurvy are vague like irritability, lack of appetite. 5 As it progresses, there will be generalized tenderness especially over long bones due to subperiosteal hemorrhage. Pseudoparalysis may become apparent due to bone pain.…”

Skeletal Manifestations of Scurvy: A Case Report from Dubai

“…Swelling may be noted along the shafts of long bones. Pseudoparalysis may be apparent as a result of the bone pain [6]. The dominant symptoms in our patient were joint swelling and pain.…”

Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide

“…This feature has been clinically observed following the reintroduction of vitamin C and resumption of osteoid formation (Noordin et al, 2012; Riepe et al, 2001). …”