Scurvy in a 10‐Year‐Old Boy

Cole, John A.; Warthan, Molly M.; Hirano, Stefanie A.; Gowen, Clarence W.; Williams, Judith V.

doi:10.1111/j.1525-1470.2010.01095.x

Cited by 32 publications

(33 citation statements)

References 9 publications

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“…[1][2][3] Few pediatric case reports of scurvy exist in the literature, [4][5][6][7][8][9] and lack of physician awareness may delay diagnosis. Children with severe eating restrictions may present with multiple nutritional deficiencies or concurrent medical conditions, complicating the detection of scurvy.…”

Section: Discussionmentioning

confidence: 99%

Petechial Rash in a Child with Autism and Trisomy 21

Sobotka¹,

Deal²,

Casper³

et al. 2014

Pediatr Ann

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A 10-year-old boy with Trisomy 21 presented to the emergency department with a history of rash on his legs, easy bruising and bleeding, and walking with a limp. One month prior to presentation, he had developed a non-pruritic, non-painful, petechial rash on his lower legs ( Figure 1). Eczema was suspected and he was treated with a topical steroid cream, but there was no improvement in the rash. Subsequently, he developed easy bruising and bleeding gums when brushing his teeth. The day prior to presentation, he began limping and then refused to walk. His parents also reported a several-month history of decreased appetite and poor weight gain. They deny any fever, night sweats, or recent illnesses.His medical history was also significant for autism, chronic constipation, and very restricted diet for the past 3 years. Over this time, his diet had been limited to peanut butter and jelly sandwiches, soy bacon, pasta, waffles, wheat porridge, cheese crackers, vanilla pudding, toaster pastries, chocolate sandwich cookies, and pretzels. He refused to eat all other foods. He was not taking any supplemental medications, vitamins, or alternative therapies. PHYSICAL EXAMINATIONOn presentation, he was noted to be a thin-appearing child who had fine, kinky hair. He was 24.5 kilograms (15 th percentile on growth curve for Trisomy 21). He had gingival swelling and bleeding around the base of several teeth, but otherwise good dentition without caries. There was blood in the left external auditory canal obscuring the left tympanic membrane; the right canal and right tympanic membrane were normal. Heart, lung, and abdominal examinations were unremarkable. His left knee was swollen without effusion or tenderness and had full range of motion; the right knee was normal. His skin was remarkable for perifollicular petechiae over bilateral lower extremities, face, and trunk, with scattered bruises over his legs. HOSPITAL COURSEHe was admitted to the hospital for further evaluation. Complete blood count, serum chemistries, liver function panel, and coagulation panel (prothrombin time, activated partial thromboplastin time, and international normalized ratio) were normal. Plain radiographs of the lower extremities were unremarkable. Additional laboratory testing confirmed the diagnosis.Editor's note: Each month, this department features a discussion of an unusual diagnosis. A description and images are presented, followed by the diagnosis and an explanation of how the diagnosis was determined. As always, your comments are welcome via email at pedann@Healio.com.

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Section: Discussionmentioning

confidence: 99%

Petechial Rash in a Child with Autism and Trisomy 21

Sobotka¹,

Deal²,

Casper³

et al. 2014

Pediatr Ann

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“…There are groups at risk, including infants who are fed with evaporated or boiled milk, in which ascorbic acid is destroyed by heat, as well as children with poor diets as a result of psychiatric or developmental disorders 7. Scurvy is still present in economically disadvantaged populations with poor nutrition 8…”

Section: Discussionmentioning

confidence: 99%

A good growth in a child with scurvy

Valentini

Barbuti²,

Grandin

et al. 2011

Case Reports

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We report on a 13-month-old boy who experienced pain while mobilising, and had bruising and swelling of the lower limbs. Laboratory examinations revealed anaemia and skeletal x-rays showed irregularity and thickening of the provisional zones of calcification of lower and upper limbs. The boy had been fed with only goat milk, homogenised meat, fruits and vegetables, all of which had been boiled together. Forty-eight hours after starting oral vitamin C supplementation, the patient showed dramatic clinical improvement. The clinical presentation, laboratory and imaging findings, together with the good response to vitamin C intake, allowed us to confirm the diagnosis of infantile scurvy. Scurvy is a disease that can be found among children, especially among groups with restrictive eating pattern. Fortunately, once diagnosed, scurvy is an easily treatable disease by administration of vitamin C and a correct diet that is rich in fruits, vegetables and fresh meat, all of which contained vitamin C.

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“…It is typically found in children with severe dietary restrictions, most commonly caused by underlying neuropsychiatric or gastrointestinal disorders. The most recent reports have been in children with autism and developmental delay who refuse to eat foods that contain sufficient vitamin C. [1][2][3] There also are more rare reports of other causes such as religious food restriction or organ failure, leading to scurvy. 4,5 This is the first presented case where vitamin C deficiency occurred due to diet restrictions placed on the child for perceived food sensitivity (caregiver concerns about the potential for severe reaction).…”

Section: Discussionmentioning

confidence: 99%

Ascorbic Acid Deficiency (Scurvy) in a Toddler With Restricted Dietary Intake Presenting With “Leg Weakness” and a Rash

Cain

Harris

Kim

et al. 2014

ICAN: Infant, Child, & Adolescent Nutrition

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Case ReportA 2-year-old unimmunized male presents to the emergency department (ED) with a 3-day history of worsening bilateral leg weakness and 6 days of petechial rash. He had a reported past medical history of protein-losing enteropathy, severe dietary sensitivity, and chronic anemia. He was seen in a primary care office 2 days prior for a petechial rash over his face and upper trunk. At that visit, concern for infectious causes prompted laboratory evaluation including the following: complete blood count (CBC) with peripheral smear, aspartate aminotransferase, alanine aminotransferase, and serologic markers for Anaplasma phagocytophila, Ehrlichia, and rubeola. The only test not within normal limits was the CBC, indicating a stable anemia that was well known prior to this episode. During the ED evaluation, the patient's mother reported the child appeared fatigued over the past several weeks as he refused to go up or down stairs and played less with siblings. She described his gait as if he was "walking on glass" and he would hold onto objects to ambulate. She had noticed that his gums were red and bled with brushing his teeth. He had no fever, upper respiratory symptoms, gastrointestinal symptoms, or change in appetite or baseline diet.In the ED, the child appeared to have decreased strength in his lower extremities as compared with the upper extremities. He had normal passive range of motion without swelling or erythema of the hips, knees, and ankles. Gait was antalgic, and he required support to walk. He had a diffuse petechial rash especially over his trunk.Lumbar puncture was performed and cerebral spinal fluid (CSF) studies were obtained out of concern for possible Guillain-Barré syndrome and were within normal limits. A CBC was repeated and demonstrated stable normocytic anemia without lymphocytosis or thrombocytopenia. Coagulation studies were unremarkable. Inflammatory markers were within normal limits. Electrolytes were

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Scurvy in a 10‐Year‐Old Boy

Cited by 32 publications

References 9 publications

Petechial Rash in a Child with Autism and Trisomy 21

Petechial Rash in a Child with Autism and Trisomy 21

A good growth in a child with scurvy

Ascorbic Acid Deficiency (Scurvy) in a Toddler With Restricted Dietary Intake Presenting With “Leg Weakness” and a Rash

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