Scurvy Masquerading as Septic Arthritis in a Case of Cerebral Palsy

Scurvy is a rarely seen in pediatric patients nowadays, seen more in those with developmental delay, autism or those who are severely malnourished. Epiphyseal separations are known to occur in scurvy, but only a few such cases have been reported in children with cerebral palsy. The diagnosis is often misleading since other morbidities as trauma, malignancies, coagulopathies, septic arthritis, osteomyelitis, or rheumatologic disorders are often considered at first. We report the case of 4-year-old female child with cerebral palsy in whom the initial concern was septic arthritis/osteomyelitis based upon clinical presentation, ultrasonic and magnetic resonance imaging, led to a surgery revealing subperiosteal hematomas.

A 4-year-old girl was admitted in the pediatrics department for fever and bilateral knee joint pain for 3 days. She was a diagnosed case of with cerebral palsy, psyco-developmental delay, and epileptogenic disorder put under valproic acid. She was toxic and febrile. Within 4 h after admission, both knees developed tense shiny intense swelling associated with pain, redness, and local rise of temperature with limited active range of motion. Near-complete passive range of motion was noted. There were no abnormal findings on the rest of the musculoskeletal examination. Aspiration of the knee revealed subperiosteal hematoma diagnostic of scurvy.

Scurvy is exceedingly rare in children nowadays; however, its presentation among risky populations should not be forgotten. Musculoskeletal revelations, mostly subperiosteal hematoma, are the main manifestation of scurvy in the pediatric population. Scurvy as a differential diagnosis for trauma, osteomyelitis, septic arthritis will always be a bane for orthopedic surgeons. A heightened awareness is needed to avoid unnecessary surgery, unnecessary tests, and procedures and to be able to start treatment for a potentially fatal but easily curable disease.