Abstract
Purpose
Scurvy, due to vitamin C deficiency, is commonly referenced as a “forgotten” or “historical” disease. A growing number of case reports challenge this notion. Bone health providers are often consulted early in the presentation of scurvy to evaluate musculoskeletal complaints resulting from impaired collagen production and disrupted endochondral bone formation. In this report, we describe two cases of childhood scurvy. Our objective is to summarize the key features of scurvy for bone health providers, with the goal of raising awareness and facilitating diagnosis in future cases.
Case descriptions
Case one occurred in a 12-year-old non-verbal, non-ambulatory female on a ketogenic diet for refractory epilepsy. Clinical findings included hemarthrosis, transfusion dependent anemia, elevated inflammatory markers, and epiphysiolysis. Magnetic resonance imaging (MRI) revealed multi-focal bone marrow signal abnormalities and physeal irregularities. Case two occurred in a typically developing 5-year-old male presenting with limp and knee pain. Symptoms progressed despite casting and immobilization. Mild anemia, elevated inflammatory markers, and multi-focal marrow and physeal MRI abnormalities were identified. Subsequent dietary history revealed total absence of fruit or vegetable consumption. The diagnosis of scurvy was confirmed in both cases by undetectable plasma vitamin C concentrations. Treatment with vitamin C led to rapid clinical improvement.
Conclusion
Scurvy can no longer be considered a historical diagnosis and should not be forgotten when evaluating children with musculoskeletal ailments. Early recognition of the signs, symptoms, and imaging findings of scurvy can reduce the clinical burden of this disease with the timely initiation of vitamin C therapy.
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This work was supported by the National Institutes of Health: K23DK114477 (DRW).
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Fig. 2
Clinical approach to the patient with suspected scurvy. Clinical evaluation of patients with signs/symptoms of scurvy should include evaluation of dietary intake by a registered dietician, as well as imaging and biochemical evaluation as outlined above. Treatment with vitamin C supplementation can be initiated before biochemical confirmation of low vitamin C in cases where there is a high index of suspicion for scurvy. CRP, c-reactive protein; ESR, erythrocyte sedimentation rate; MRI, magnetic resonance imaging(PNG 791 kb)
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Alten, E., Chaturvedi, A., Cullimore, M. et al. No longer a historical ailment: two cases of childhood scurvy with recommendations for bone health providers. Osteoporos Int 31, 1001–1005 (2020). https://doi.org/10.1007/s00198-019-05264-4
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DOI: https://doi.org/10.1007/s00198-019-05264-4