The Subtle Signs of Scurvy: A Paediatric Case Misleading Clinicians

Scurvy, arising from vitamin C deficiency, remains relevant despite historical declines. Scurvy commonly presents with severe leg pain, reluctance to walk, and limping. Other symptoms include gingival bleeding, hypertrophy, and ecchymoses. Due to its rarity in the paediatric population, vitamin C deficiency poses a diagnostic challenge. This case report details a 3-year-old boy presenting with a four weeks' history of being unable to bear weight and fine petechial rashes on lower limbs, initially evaluated for an injury. With no apparent fractures from the X-rays, further investigations were carried out, including MRI Short Tau Inversion Recovery (STIR). The MRI STIR results revealed bone and soft tissue oedema, prompting concerns about systemic disorders. Abnormal blood results, coupled with comorbidities such as suspected autistic spectrum disorder, triggered collaboration among paediatric, orthopaedic, and haematology/oncology specialists. Extensive imaging and consultations unveiled a diagnosis of scurvy, illustrating the challenges in recognizing this vitamin deficiency amid overlapping symptoms with serious conditions. The interdisciplinary team initiated treatment with oral ascorbic acid and analgesia, addressing the patient's reluctance to consume a varied diet. Parental decline for measuring ascorbic acid levels added complexity. Following a multi-disciplinary approach involving paediatric dietitians and physiotherapists, the patient exhibited positive progress, emphasizing the importance of tailored interventions. This case highlights the diagnostic challenges posed by scurvy's diverse clinical presentations and the imperative for healthcare providers to recognize its potential, especially in cases involving musculoskeletal symptoms. The enduring relevance of scurvy in contemporary healthcare underscores the need for heightened awareness, interdisciplinary collaboration, and ongoing monitoring, emphasizing both short-term treatment and long-term preventive measures through dietary habits.