title: Improper Use of a Plant-Based Vitamin C-Deficient Beverage Causes Scurvy in an Infant.
abstract: Scurvy is a rare disease in developed countries. Risk groups include children with restricted diets, mainly patients who are autistic or have cerebral palsy. Furthermore, consumption of plant-based beverages has increased in recent years, especially in developed countries. When plant-based beverages are the exclusive diet in the first year of life and not consumed as a supplement to formula or breastfeeding, it can result in severe nutritional problems. We report a case of scurvy after exclusive intake of almond beverages and almond flour from 2.5 to 11.0 months of life. The patient was referred for pathologic fractures of the femur, irritability, and failure to thrive. He had typical radiologic signs of scurvy, such as osteopenia, cortical thinning, Wimberger ring, Frankel line, fracture, and periosteal reaction. Moreover, his plasmatic vitamin C level was very low. The child was diagnosed with scurvy and was started on vitamin C replacement therapy at a dose of 300 mg per day. Over the following 3 months, his general condition, the pain in the legs, and the radiologic features improved; the plasmatic vitamin C level was normalized; and the child started walking. In summary, this case demonstrates that scurvy is a new and severe complication of improper use of almond drinks in the first year of life. Manufacturers should indicate that these beverages are inappropriate for infants who consume a vitamin C-deficient diet.
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain; and vitoria_isi@gva.es.
authors.forename: Isidro
authors.initials: I
authors.lastname: Vitoria
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain; and.
authors.forename: Berta
authors.initials: B
authors.lastname: López
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain; and.
authors.forename: Jacinto
authors.initials: J
authors.lastname: Gómez
authors.affiliation: Pediatric Department, Hospital Elda, Alicante, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Torres
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain; and.
authors.forename: María
authors.initials: M
authors.lastname: Guasp
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain; and.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Calvo
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain; and.
authors.forename: Jaime
authors.initials: J
authors.lastname: Dalmau
mesh_terms: D001628:Beverages; D001851:Bone Diseases, Metabolic / Q000209:etiology; D004032:Diet / Q000009:adverse effects*; D005183:Failure to Thrive / Q000209:etiology; D005264:Femoral Fractures / Q000209:etiology; D005433:Flour; D006801:Humans; D007223:Infant; D007508:Irritable Mood; D008297:Male; D000068181:Prunus dulcis; D012614:Scurvy / Q000209:etiology*; D014808:Vitamin D Deficiency / Q000209:etiology