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Scurvy in a Pediatric Patient With Autism and Limp: A Case Report
Christopher Luckow1, Anita A Thomas2
1Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.
Insights
Scurvy, a vitamin C deficiency, can cause limping and rash in children with developmental delays. Emergency physicians should consider scurvy in their differential diagnosis for pediatric limp.
Area of Science:
- Pediatric Emergency Medicine
- Nutritional Deficiencies
- Skeletal Dysplasias
Background:
- Limping is a frequent pediatric emergency department (ED) chief complaint.
- Assessment can be challenging in patients with developmental delay.
Observation:
- A 5-year-old nonverbal autistic male presented with a month-long history of progressive limp, weakness, pain, and rash.
- Magnetic resonance imaging (MRI) revealed multifocal osseous marrow signal abnormalities.
Findings:
- The findings were consistent with vitamin C deficiency (scurvy).
- Scurvy can manifest with nonspecific symptoms like limp, rash, and bone pain.
Implications:
- Consider scurvy in pediatric patients with developmental/sensory delay and restricted diets.
- Broaden differential diagnoses for pediatric limp to include nutritional deficiencies like scurvy.
Background:
Limping is a common chief complaint in the pediatric emergency department (ED) and can be difficult to assess in pediatric patients, particularly if they have developmental delay.
Case Report:
We present a case of a 5-year-old male with nonverbal autism who presented with a progressive limp, weakness, pain, and rash over the course of 1 month. A magnetic resonance imaging scan of the pelvis performed while the patient was sedated revealed multifocal osseous marrow signal abnormalities, ultimately consistent with vitamin C deficiency or scurvy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Scurvy can present with nonspecific limp, rash, and bony pain and should be considered in pediatric patients with developmental/sensory delay who may restrict their diets. Emergency physicians should broaden their differential diagnoses to nutritional deficiencies such as scurvy in the evaluation of pediatric patients with limp.
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