Scurvy: Forgotten diagnosis, but still exist

Miraj, Faisal; Abdullah, Aszrin

doi:10.1016/j.ijscr.2020.03.002

Cited by 14 publications

(13 citation statements)

References 11 publications

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“…Recent studies have also documented the occurrence of scurvy in healthy "picky eaters" who choose to consume primarily carbohydrates and no vegetables or fruits. 9 The majority of our patients were male (94%) and their median age at presentation was 4.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) years. According to this study, the median age at onset is 42 months, and males are disproportionately affected (74%).…”

Section: Discussionmentioning

confidence: 95%

“…Before being referred to an orthopedic surgeon for evaluation of the findings on musculoskeletal and radiographs, all patients were evaluated by their primary care physicians. This study included 17 males and 1 female, with a median age of 4.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) years at presentation. The average BMI was 13.93 ± 0.62 kg/m 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Scurvy lines or scorbutic zone means transverse bands of decreased density adjacent to the Frankel sign and Corner sign (Pelkan's spur), a lateral metaphyseal spur resulting from infarctions. 11 Only during the recovery phase of scurvy can paraepiphyseal subperiosteal hemorrhages be detected. 3 A lack of collagen can lead to physiolysis and epiphyseal separations in bones that are structurally fragile and have a diminished capacity to withstand load-bearing stresses or intense muscular tension.…”

Section: Methodsmentioning

confidence: 99%

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Lessons learned from “the great mimicker disease”: A retrospective study of 18 patients with scurvy

Miraj,

Karda,

Abdullah

et al. 2023

Journal of Children's Orthopaedics

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Purpose: Scurvy is an uncommon medical condition that affects children and is caused by an inadequate intake of vitamin C. This study presents the characteristics of patients with scurvy to raise awareness of the diagnostic process in developing countries where laboratory testing for vitamin C levels is often not available. Methods: A retrospective study was performed from period of 2018 to 2023. Data extraction includes patient age, sex, body mass index, constitutional symptoms, musculoskeletal, mucosal, cutaneous symptoms, other accompanying disorders, anemia, erythrocyte sedimentation rate, C-reactive protein, radiographic examination, vitamin C dose, and duration of treatment. Descriptive statistical analysis was performed in this study. Results: Eighteen cases (17 males, 1 female) of scurvy were referred to our institution. Thirteen of 18 patients were misdiagnosed before referral. The median age at presentation was 4.5 (range, 2–11) years. The average body mass index was 13.93 ± 0.63 kg/m2. Half of patients had healthy weight. All patients presented with lower limb pain and 17 of 18 with refusal to walk. The median onset of diagnosis was 11 (range 4–48) weeks. White line of Frankel was described in all patients. Seven had anemia and 6 of 18 had increase in erythrocyte sedimentation rate and/or C-reactive protein levels. Only one patient had ascorbic acid levels evaluation before treatment since it was not readily available in our country. Treatment length varied from 2 weeks to 6 months. Conclusion: The diagnosis of scurvy is frequently delayed due to its extreme rarity in modern society and its ability to mimic numerous other conditions. In children presenting with limb pain and/or reluctance to walk and pathognomonic radiological findings, physicians must prioritize scurvy as a differential diagnosis. In scurvy, vitamin C supplementation is curative.

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Section: Discussionmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Lessons learned from “the great mimicker disease”: A retrospective study of 18 patients with scurvy

Miraj,

Karda,

Abdullah

et al. 2023

Journal of Children's Orthopaedics

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“…Scurvy often presents as musculoskeletal symptoms in children 1,[3][4][5][6]8,11 , and bone changes on radiographs have been well described. The typical radiographic findings associated with scurvy include osteopenia, periosteal reaction, metaphyseal spurs associated with a healing metaphyseal fracture (Pelkan spurs), dense metaphyseal lines (Frankel's line), lucent metaphyseal bands (Trummerfeld zone), a calcified epiphyseal ring (Wimberger's Ring), and epiphysiolysis (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Children may also develop mucocutaneous and hematologic symptoms including gingival bleeding, petechiae, ecchymosis, hemarthrosis, perifollicular hemorrhage, and corkscrew hairs 1,2,7-10 . Musculoskeletal manifestations of scurvy include lower limb pain, limping, and refusal to walk 1,[3][4][5][6]8,11 . Musculoskeletal symptoms often occur later in the course of the disease; however, they are commonly the presenting signs in children 3,7,12 .Previous studies have shown that children in low-income and food-insecure households eat less nutrient-dense foods such as fruits and vegetables 13,14 and may be at increased risk for some Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C300).…”

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confidence: 99%

Orthopaedic Manifestations of Scurvy in an Otherwise Healthy Child from a Low Opportunity Index Neighborhood

Falkenberg,

Karkenny,

Sharkey

2024

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Case: A 23-month-old otherwise healthy female child from a low opportunity index neighborhood presented with 1 month of lower extremity pain and refusal to bear weight. Radiographic evaluation of bilateral knees revealed lucent metaphyseal bands and a nondisplaced distal femoral metaphyseal corner fracture. A workup identified vitamin C deficiency (scurvy), and the child's symptoms and radiographic abnormalities resolved with vitamin C supplementation. Conclusions: Scurvy should be considered in children with unexplained musculoskeletal symptoms who may lack access to nutrient-dense foods.

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