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Scurvy revealed by difficulty walking: three cases in young children
Maleewan Kitcharoensakkul1, Christa G Schulz, Rachel Kassel
1From the Departments of *Pediatrics and †Radiology, Washington University School of Medicine, St Louis, MO.
Summary
Scurvy, a vitamin C deficiency, can cause leg pain and difficulty walking in children, even without typical gum symptoms. Early diagnosis and vitamin C treatment lead to recovery.
Area of Science:
- Pediatrics
- Nutrition
- Rheumatology
Background:
- Scurvy, caused by ascorbic acid deficiency, is rare in developed nations.
- It classically presents with lower-extremity pain and reluctance to ambulate in children.
- Recognition and diagnosis have declined due to its rarity.
Observation:
- Three young children presented with difficulty walking and leg pain.
- Only one patient exhibited gingival lesions.
- Extensive hematologic and rheumatologic workups preceded the scurvy diagnosis in two cases.
Findings:
- All patients had limited fruit and vegetable intake due to oral aversion; one had autism.
- Radiographic examination revealed long bone abnormalities in all three.
- Concomitant vitamin D deficiency was noted in all cases.
Implications:
- Rheumatologists should consider scurvy in nonambulatory children, even with atypical presentations.
- Dietary history, focusing on fruit and vegetable intake, is crucial.
- Prompt vitamin C supplementation resolves symptoms and improves mobility.
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