Scurvy presenting as difficulty in walking in a child.
Heidi Nerissa Zhixuan YuShi Yun ChiaPublished in: BMJ case reports (2023)
Scurvy, a disease caused by ascorbic acid (vitamin C) deficiency, is a rare disease in the modern world. We report a case of a boy in middle childhood, with a background of autism, presenting bed-bound due to progressive bilateral lower limb pain, with concomitant rashes, bleeding gums and worsening lethargy. Detailed dietary history revealed a severely restricted diet. Physical examination showed bilateral lower limb ecchymoses, perifollicular hemorrhages, perifollicular hyperkeratosis and cockscrew hairs which are pathognomonic features of scurvy. A low serum ascorbic acid level confirmed the diagnosis. Therapy with oral vitamin C supplement and rehabilitation with multidisciplinary care was successful, with complete resolution of symptoms. This case emphasises the importance of thorough dietary evaluation in children with autism and food selectivity presenting with non-specific symptoms. Physician awareness of nutritional deficiencies avoids unnecessary extensive investigations and sub-specialty referrals and translates to savings in medical expenses.
Keyphrases
- lower limb
- case report
- autism spectrum disorder
- healthcare
- intellectual disability
- physical activity
- mental health
- pain management
- primary care
- quality improvement
- chronic pain
- multiple sclerosis
- emergency department
- sleep quality
- palliative care
- atrial fibrillation
- risk assessment
- bone marrow
- spinal cord
- human health
- cell therapy