Scurvy Masquerading as Malignancy: A Diagnostic Challenge in a Child With Severe Selective Eating

Scurvy, caused by severe vitamin C deficiency, is increasingly being reported in modern developed countries, particularly among children with restrictive diets. The non-specific presentation often leads to extensive investigations and diagnostic delays. We report the case of a 5.5-year-old boy born to consanguineous parents, with a history of language delay and severe selective eating, who presented with a two-week history of progressive limping and hemorrhagic gingival hypertrophy. Initial workup raised suspicion for hematologic malignancy, prompting extensive investigations, including bone marrow aspiration and maxillary biopsy, all of which were negative. A detailed dietary history revealed an extremely restricted diet consisting solely of pasteurized milk and biscuits for over three years. The vitamin C level was severely low at 3 µmol/L (normal range: 26-84 µmol/L), confirming the diagnosis of scurvy. Treatment with intravenous vitamin C (250 mg daily for one week) followed by oral supplementation resulted in dramatic improvement, with the patient regaining ambulation within 48 hours. Complete clinical and biochemical resolution occurred within three months. This case highlights the critical importance of obtaining a detailed dietary history in children presenting with unexplained musculoskeletal symptoms, hemorrhagic manifestations, or failure to thrive. Scurvy remains a relevant diagnosis in modern pediatric practice, particularly among children with neurodevelopmental conditions and food selectivity. Early recognition can prevent unnecessary invasive procedures and expensive diagnostic workups.