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[Multiple epiphyseal separations in a child with cerebral palsy and scurvy]
O Iacono1, A Datola, M L Barbagallo
1Unità Operativa Clinica Pediatrica, Dipartimento di Pediatria, Università degli Studi di Catania, Catania, Italia. oriana.i@tiscali.it
Insights
Scurvy, a vitamin C deficiency disease, can present with severe symptoms like bone fractures and bleeding. This case highlights its increased risk and severity in children with cerebral palsy.
Area of Science:
- Nutrition and Metabolism
- Pediatric Diseases
- Skeletal Disorders
Background:
- Scurvy is a preventable disease caused by Vitamin C deficiency, crucial for collagen synthesis.
- While rare in industrialized nations, scurvy is linked to malnutrition, malabsorption, alcoholism, and cerebral palsy.
- Clinical manifestations include fatigue, weight loss, irritability, bleeding gums, and severe bone pain due to fractures and subperiosteal hematomas.
Observation:
- A 9-year-old girl with spastic quadriplegic cerebral palsy presented with severe anemia and fever.
- Radiographic examination revealed multiple epiphyseal separations in the right shoulder and left knee.
- These findings, in conjunction with clinical symptoms, led to a diagnosis of scurvy.
Findings:
- The case underscores the potential for severe scurvy presentation in pediatric patients with cerebral palsy.
- Vitamin C deficiency can manifest with significant orthopedic complications, mimicking other pediatric bone disorders.
- Prompt diagnosis and treatment with ascorbic acid supplementation are essential for recovery.
Implications:
- Cerebral palsy patients are at higher risk for scurvy due to potential nutritional and absorption challenges.
- Early recognition of scurvy's diverse clinical features is vital, especially in at-risk populations.
- Effective treatment with ascorbic acid leads to complete recovery from scurvy-related injuries within months.
Abstract:
Scurvy is a dietary disease due to Vitamin C deficiency. Vitamin C is related to collagen synthesis and metabolism. Malnutrition, problems in bowel absorption, alcoholism and cerebral palsy are clearly often linked with scurvy, even it is no more common in the industrialized countries. Its clinical features are: asthenia, weight loss, appetite decrease, irritability, gingival or mucous lesions, porpora, follicular hyperkeratosis, musculoskeletal pain due to multiple fractures and subperiosteal bleedings, pseudoparalisis (frog-like position of legs) and refuse to walk. Authors report on a nine year-old girl with spastic quadriplegic cerebral palsy, who at the first examination showed deep anemia, fever and multiple epiphyseal separation of the right shoulder and the left knee. Diagnosis of scurvy was been made. The aim of this article was to underline the rarity and gravity of this disease, and its even more frequent appearance in children affected of cerebral palsy. Substitutive therapy consists on ascorbic acid supplementation. Complete restitutio ad integrum of skin-mucous injuries, such as gingival bleedings, was achieved within three months.
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