Scurvy: A rare cause for limp in a child with autism spectrum disorder

Andrews, Sarah; Iyer, Shobha; Rodda, Christine; Fitzgerald, John F.

doi:10.1111/jpc.14098

Cited by 7 publications

(7 citation statements)

References 4 publications

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“…Children with underlying neurodevelopmental conditions such as autistic spectrum disorder have restricted eating behaviours hence predisposing them to deficiency of vital micronutrients. 8 In this case, a diagnosis of autism followed a persistent questioning of the diet. It was important to note that reviewing weight alone did not highlight issue as he was on the 50th percentile for his age.…”

Section: Discussionmentioning

confidence: 88%

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Easily missed, easily treatable: A case of non‐weight bearing, an MRI and scurvy

Ding¹,

Goh

Hayman³

2022

J Paediatrics Child Health

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Section: Discussionmentioning

confidence: 88%

“…The second important feature in this case was dietary history. Children with underlying neurodevelopmental conditions such as autistic spectrum disorder have restricted eating behaviours hence predisposing them to deficiency of vital micronutrients 8 . In this case, a diagnosis of autism followed a persistent questioning of the diet.…”

Section: Discussionmentioning

confidence: 92%

Easily missed, easily treatable: A case of non‐weight bearing, an MRI and scurvy

Ding¹,

Goh

Hayman³

2022

J Paediatrics Child Health

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“…The large majority of children with scurvy have underlying conditions predisposing them to nutritional imbalances. Neuropsychiatric or developmental disorders, such as autism spectrum disorders, cerebral palsy and developmental delay, are the most common, as these patients are more prone to restrictive diets owing to sensory issues ( 3 , 13 – 15 ). Other diseases may increase the risk of vitamin C deficiency by reducing its absorption (Crohn's, Whipple's, and celiac disease) ( 16 ), increasing its requirement (chemotherapy, bone marrow transplant, hemodialysis) ( 17 – 19 ), or accelerating its catabolism (iron overload) ( 19 ).…”

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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“…Literature reviewed yielded 77 cases of scurvy described in 65 published papers (Table S1), in addition to the two cases described here 1,8,9,11‐73 …”

Section: Literature Reviewmentioning

confidence: 99%

“…Vitamin C is absorbed from the gastrointestinal tract 6,8 . It is not stored in any reservoir within the body and is widely distributed in intracellular and extracellular tissues 6 .…”

Section: Introductionmentioning

confidence: 99%

The risk for scurvy in children with neurodevelopmental disorders

Kothari¹,

Tate

Adewumi

et al. 2020

Special Care in Dentistry

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Background: Scurvy, the disease resulting from vitamin C deficiency, is perceived as being rare and occurring predominantly in the past. However, scurvy continues to exist and may be encountered in children with medical/developmental conditions and/or restricted diet. Diagnosis can be challenging given the perceived rarity of the condition and nonspecific symptoms, including gingival disease. Methods:We present a series of two cases of scurvy in which the affected children presented to medical attention with dental complaints. Additional cases of scurvy are described, based on the literature review of case reports/series published in the last 10 years.

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Scurvy: A rare cause for limp in a child with autism spectrum disorder

Cited by 7 publications

References 4 publications

Easily missed, easily treatable: A case of non‐weight bearing, an MRI and scurvy

Easily missed, easily treatable: A case of non‐weight bearing, an MRI and scurvy

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

The risk for scurvy in children with neurodevelopmental disorders

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