title: Childhood scurvy: an unusual cause of refusal to walk in a child.
abstract: Scurvy, or vitamin C deficiency, is rarely presented to a rheumatology clinic. It can mimic several rheumatologic disorders. Although uncommon, it may present as pseudovasculitis or chronic arthritis. Scurvy still exists today within certain populations, particularly in patients with neurodevelopmental disabilities, psychiatric illness or unusual dietary habits.Scurvy presentation to the rheumatologist varies from aches and mild pains to excruciating bone pain or arthritis. Musculoskeletal and mucocutaneous features of scurvy are often what prompts referrals to pediatric rheumatology clinics. Unless health care providers inquire about nutritional habits and keep in mind the risk of nutritional deficiency, it will be easy to miss the diagnosis of scurvy. Rarity of occurrence as compared to other nutritional deficiencies, combined with a lack of understanding about modern-day risk factors for nutritional deficiency, frequently leads to delayed recognition of vitamin C deficiency. We report a case of scurvy in a mentally handicapped Saudi child, who presented with new onset inability to walk with diffuse swelling and pain in the left leg. Skin examination revealed extensive ecchymoses, hyperkeratosis and follicular purpura with corkscrew hairs, in addition to gingival swelling with bleeding. Clinical diagnosis of scurvy was rendered and confirmed by low serum vitamin C level. The patient did extremely well with proper nutritional support and vitamin C supplementation. It has been noticed lately that there is increased awareness about scurvy in rheumatology literature. A high index of suspicion, together with taking a thorough history and physical examination, is required for diagnosis of scurvy in patient who presents with musculoskeletal symptoms. Nutritional deficiency should also be considered by the rheumatologist formulating differential diagnosis for musculoskeletal or mucocutaneous complaints in children, particularly those at risk.
authors.affiliation: Department of Pediatrics, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia. qanatishj@ngha.med.sa.
authors.forename: J T
authors.initials: JT
authors.lastname: Alqanatish
authors.affiliation: Department of Pediatrics, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: F
authors.initials: F
authors.lastname: Alqahtani
authors.affiliation: Department of Pediatrics, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: W M
authors.initials: WM
authors.lastname: Alsewairi
authors.affiliation: Department of Dermatology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: S
authors.initials: S
authors.lastname: Al-kenaizan
mesh_terms: D001168:Arthritis / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D001206:Ascorbic Acid Deficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D002908:Chronic Disease; D019587:Dietary Supplements; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D045808:Refusal to Participate / Q000523:psychology*; D012614:Scurvy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
chemical_list: D001205:Ascorbic Acid