Scurvy: a case report

An 8-year-old child with cerebral palsy came with progressive purpuric rash affecting the trunk and legs. He had tenderness on palpation of his extremities. Physical examination revealed a moderately pale and cachectic boy. There was bleeding per swollen gums and petichiae on the hard palate. Generalized multiple discrete palpable petichiae spots at hair follicles along the whole body, more on both legs, were observed. He also had tenderness on palpation of his extremities. His hemoglobin was 6.6 g/dl. Platelet count and coagulogram were normal. Roentgenographic findings showed generalized osteoporosis, metaphyseal white line of distal femur, proximal tibia. proximal fibula, distal radius, and distal ulna with submetaphyseal lucency bilaterally. Skin biopsy showed dilated hair follicles, filled with keratinous material and a small corkscrew hair. A diagnosis of scurvy was made; and vitamin C at a dosage of 300 mg per day was given. His swollen gums, bleeding per gums and muscle tenderness improved within 2 days. Perifollicular hemorrhage, follicular hyperkeratosis, and anemia improved in 2 and 3 weeks respectively.