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Published on: September 20, 2018
A Narrative Review on Pediatric Scurvy: The Last Twenty Years
Sandra Trapani1, Chiara Rubino2, Giuseppe Indolfi3
1Pediatric Unit, Department of Health Sciences, Meyer Children's University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy.
Insights
Scurvy, caused by vitamin C deficiency, is increasingly seen in children with poor diets or disabilities. Early diagnosis is crucial to prevent severe complications and avoid misdiagnosis.
Area of Science:
- Pediatrics
- Nutrition
- Clinical Medicine
Background:
- Scurvy, a condition resulting from vitamin C deficiency, is increasingly diagnosed in children, particularly those with specific dietary or developmental challenges.
- While historically rare in developed nations, recent trends show a rise in pediatric scurvy cases, often linked to atypical dietary patterns or disabilities.
Purpose of the Study:
- To review the clinical manifestations, diagnostic challenges, and delays in diagnosing scurvy in children.
- To analyze recent literature on pediatric scurvy, focusing on its varied presentation and differential diagnoses.
Main Methods:
- Extensive literature review of studies published in the last 20 years.
- Analysis of 15 selected articles reporting on 166 children with scurvy.
- Focus on clinical features, differential diagnosis, and diagnostic delay.
Main Results:
- Scurvy presents a wide clinical spectrum, mimicking autoimmune diseases, infections, and cancers.
- Normal nutritional status, anemia, or elevated inflammatory markers can lead to misdiagnosis.
- Musculoskeletal complaints are key indicators, even in otherwise healthy children.
Conclusions:
- Scurvy should be considered in children with musculoskeletal complaints, regardless of risk factors.
- Dietary history and physical examination are essential; serum vitamin C levels confirm diagnosis.
- Prompt diagnosis and treatment are vital to prevent severe outcomes and unnecessary medical interventions.
Abstract:
Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. We performed an extensive review of the literature analyzing studies published in the last 20 years focusing on clinical features, differential diagnosis and diagnostic delay. Fifteen articles were selected, collectively reporting a total of 166 children. Because of the wide clinical spectrum (musculoskeletal complaints and/or mucocutaneous lesions or systemic symptoms), scurvy can mimic several conditions, including autoimmune diseases, infections, and neoplasia. In addition, frequent findings such as normal nutritional status, anemia or elevated inflammatory markers may guide clinicians towards the abovementioned misdiagnoses. Scurvy should be considered in patients presenting with musculoskeletal complaints, not only in those with risk factors but also in healthy children. A focused dietary history and a careful physical examination, assessing other signs of vitamin C deficiency, are mandatory in these patients. When suspected, the dosage of serum vitamin C is the diagnostic gold standard; furthermore, imaging studies, performed by an expert radiologist, can reveal the typical features of scurvy. Only early diagnosis can avoid unnecessary investigations and potentially fatal complications of the disease.
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