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"What can you C in a limping child?" Scurvy in an otherwise healthy "picky eater"
Khulud Diab Shehade1, Ron Lamdan2, Dvora Aharoni3
1Department of Pediatrics, Assuta Ashdod Hospital, Ashdod, Israel.
Insights
Scurvy, a vitamin C deficiency, can affect healthy children with poor diets. This case highlights the need for nutritional assessment beyond growth charts to ensure adequate vitamin C intake.
Area of Science:
- Pediatrics
- Nutrition
- Metabolic Bone Disease
Background:
- Scurvy, historically associated with nutritional deficiencies, is rarely seen in developed countries.
- This case involves a healthy 3-year-old child presenting with symptoms mimicking other serious conditions.
Observation:
- A 3-year-old presented with limping, bone pain, fatigue, and agitation.
- Imaging suggested a metabolic bone disease, later identified as scurvy.
- Dietary history revealed extreme picky eating with a diet solely of dairy pudding.
Findings:
- Diagnosis confirmed by critically low vitamin C levels.
- Magnetic resonance imaging findings were consistent with scurvy.
- Rapid recovery followed intravenous vitamin C administration.
Implications:
- Scurvy can occur in healthy children due to highly restrictive diets.
- Highlights the importance of detailed nutritional history in pediatric cases.
- Standard growth charts may not suffice for identifying nutritional deficiencies.
Abstract:
We present a case of an otherwise healthy 3-year-old child who presented with limping, bone pain, fatigue, and agitation. Differential diagnosis included an infection of the bone, malignancy, an inflammatory bone disease, and metabolic bone disease. Magnetic resonance imaging of the lower limbs and the spine was consistent with scurvy, and the diagnosis was confirmed by very low levels of vitamin C. Further history taking revealed a diet based entirely on dairy pudding, with no fruits or vegetables, and being a "picky eater" was the sole reason. Intravenous treatment with vitamin C led to full recovery. Previous reports of scurvy were in patients with other medical conditions, such as malabsorption, or behavioral conditions as in autism. This case demonstrates that scurvy, an almost forgotten condition from past centuries, can occur in otherwise healthy children and should raise awareness regarding the importance of a balanced diet and proper nutritional history taking. Following growth charts as the only screening tool for balanced and inclusive nutrition may not be sufficient.
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