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A non-pruritic, non-painful, petechial rash on lower leg of 10-year-old boy with Trisomy 21.
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Scurvy is a disease caused by a deficiency of vitamin C. This disease is rare in developed countries, but can
occur in developing countries that face food shortages and humanitarian crises. In these countries, the
diagnosis is often missed due to the lack of adequate diagnostic equipment. We report a case of scurvy in a
2-year-old boy who was dia...
We report a case of scurvy. Presentation at six months of age is being reported for the first time as only prolonged deficiency of vitamin C leads to florid scurvy. Literature review for last twenty years has revealed that except from Thailand, disease is quite rare now a days and not even 50 cases have been reported in children in this period.
The sequence encountered in healing skin wounds in scorbutic guinea pigs has been examined by methods of light and electron microscopy. Linear incisions in the skin of female guinea pigs fed a scorbutigenic diet were allowed to heal. The wounds were removed for examination at 1, 3, 5, 9, and 14 days after wounding. The fibroblasts of the scorbutic...
Scurvy is an uncommon disease nowadays but still presents in specific groups with hypovitaminosis. This article reports the case of an adolescent patient who started with non-specific symptoms and evolved with important systemic manifestations. The diagnosis of scurvy was not initially suspected and it was evaluated by several specialties. Several...
Citations
... Rana et al. 34 3 3 3 3 3 3 3 Shetty et al. 35 3 3 3 3 3 3 3 3 3 b Sobotka et al. 37 was described as "supplementation" or "repletion." Two of these cases involved placement of a gastrostomy tube. ...
... In countries with wide availability of food fortification and nutritional supplementation, scurvy is unexpected and potentially underdetected. 36 Although certain adult populations (e.g., the elderly and individuals with a history of alcohol or drug abuse) 36,37 are recognized to be at increased risk for scurvy, much less is known about highrisk pediatric populations. This systematic review suggests that children with autism spectrum disorder (ASD) and severe food selectivity consistent with avoidant-restrictive food intake disorder (ARFID) as manifested by significant nutritional deficiency are vulnerable for scurvy. ...
Objective
To assess characteristics and outcomes of young children receiving intensive multidisciplinary intervention for chronic food refusal and feeding tube dependence.
Study design
We conducted a retrospective study of consecutive patients (birth to age 21 years) admitted to an intensive multidisciplinary intervention program over a 5-year period (June 2014-June 2019). Inclusion criteria required dependence on enteral feeding, inadequate oral intake, and medical stability to permit tube weaning. Treatment combined behavioral intervention and parent training with nutrition therapy, oral-motor therapy, and medical oversight. Data extraction followed a systematic protocol; outcomes included anthropometric measures, changes in oral intake, and percentage of patients fully weaned from tube feeding.
Results
Of 229 patients admitted during the 5-year period, 83 met the entry criteria; 81 completed intervention (98%) and provided outcome data (46 males, 35 females; age range, 10-230 months). All patients had complex medical, behavioral, and/or developmental histories with longstanding feeding problems (median duration, 33 months). At discharge, oral intake improved by 70.5%, and 27 patients (33%) completely weaned from tube feeding. Weight gain (mean, 0.39 ± 1 kg) was observed. Treatment gains continued following discharge, with 58 patients (72%) weaned from tube feeding at follow-up.
Conclusions
Our findings support the effectiveness of our intensive multidisciplinary intervention model in promoting oral intake and reducing dependence on tube feeding in young children with chronic food refusal. Further research on the generalizability of this intensive multidisciplinary intervention approach to other specialized treatment settings and/or feeding/eating disorder subtypes is warranted.
... Traumatic injury in the patients with scurvy may increase the severity of subperiosteal bleeding, and may prolong the clinical course as well as the treatment responses. Although there were some reports of various clinical presentations among children with scurvy (1)(2)(3)(4)(5) , there was limited evidence of traumatic injury in scurvy. In this case report, the researchers had the purpose to demonstrate a boy, diagnosed as scurvy, who sustained an injury at his left thigh and to describe his clinical presentations, diagnostic tests, clinical decision, treatment methods, and prognosis. ...
... A previous study from Thailand in 2003 (1) reported the most common clinical presentations in 28 children were inability to walk (96%), followed by limb pain (96%) tenderness of lower limbs (86%), and minor trauma (46%). Other studies (2)(3)(4)(10)(11)(12)(13)(14)(15) documented chief complaints mostly gum bleeding, inability to walk, limb pain or swelling caused by subperiosteal bleeding (Table 1). In this study, the child had prolonged high fever for 11 days after taking standard a vitamin C supplement (300 mg/day). ...
... The delayed clinical responses and severe marrow involvement may occur from 1) profound subperiosteal bleeding due to traumatic injury, and substantially low level of vitamin C, and 2) impending infected hematoma according to massive subperiosteal bleeding and dental caries. Compared with other studies (1)(2)(3)(4)(9)(10)(11)(12)(13)(14)(15)(16)(17) , fever was only 18% and usually subsided by one week after the treatment (1) . The radiographic findings were typically scurvy characteristics but had more extensive bone marrow enhancement than other previous reports (9,12,15) . ...
This case report aimed to describe the clinical presentation, treatments and prognosis of a child who had scurvy and traumatic injury of the left thigh. A 30-month-old boy had presented with left hip pain two weeks after falling down on the floor while walking. He developed pain, warmness of the left hip and thigh, and finally was unable to bear weight. He also had a high fever, gingival hemorrhage, dental caries, petechiae, positive rolling test and limited range of motion of the left hip. The radiographs revealed Wimberger’s ring and Frenkel line as scurvy. Vitamin C supplement had been prescribed for one week. However, there was no clinical response and magnetic resonance imaging (MRI) suggested subperiosteal abscess as well as osteomyelitis of bilateral femurs and tibias. Debridement and biopsy of the left femur were performed and found only subperiosteal blood. A clinical improvement was noted on the second day after surgery. Vitamin C level was reported at 0.03 mg/dl which was very low. Bacterial culture was negative and the pathological findings were callus formation with hemorrhage. The patient continued the treatment for two months and all conditions were healed eventually. In severe scurvy with trauma, prolonged subperiosteal hematoma was susceptible to infection, and may need debridement simultaneously with vitamin C supplement to shorten the clinical course.
Background
The demographics, weight statuses, and dietary patterns of people with autism or the broad autism phenotype who experience a severe nutrient deficiency disease due to symptoms of avoidant/restrictive food intake disorder have not been well established.
Objective
The primary objective of this review was to examine the relationship between the demographics, weight statuses, dietary patterns, and nutrient deficiency diseases that characterize the most severe manifestations of avoidant/restrictive food intake disorder symptomology associated with autism or the broad autism phenotype.
Methods
A systematic review of English and non-English articles published up to August 29, 2019, on the Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature Plus electronic databases was conducted. Additional cases were identified through the reference list of all included articles. The search terms used were “autis∗ AND (deficiency OR scurvy)”. Only case reports or case series in which a person of any age who had been identified as having a formal diagnosis of autism or autism symptoms and a disease of nutritional deficiency due to self-imposed dietary restrictions were included. Data were independently extracted by 8 authors using predefined data fields.
Results
A total of 76 cases (patients were aged 2.5 to 17 years) from 63 articles that were published from 1993 through 2019 were found. More than 85% cases (65 of 76 patients) were from articles published in the past 10 years. The largest percentage of published cases (69.7% [53 of 76]) involved scurvy, a vitamin C deficiency. The second-largest percentage of published cases (17.1% [13 of 76]) involved eye disorders secondary to vitamin A deficiency. Other primary nutrient deficiencies reported were thiamin, vitamin B-12, and vitamin D. In 62.9% (22 of 35) of the patients for which a body mass index or a weight percentile for age was provided, the patient was within normal weight parameters, per Centers for Disease Control weight status categories.
Conclusions
Based on the 63 articles extracted for this systematic review, nutritional deficiency diseases related to inadequate intakes of vitamin A, thiamin, vitamin B-12, vitamin C, and vitamin D were found in individuals with autism and the broad autism phenotype who had severe self-imposed dietary restrictions. When weight information was provided, most of the youth in these cases were not reported to be underweight. Individuals of any weight who present with symptoms of avoidant/restrictive food intake disorder can benefit from early and frequent screening for adequacy of micronutrient intake, regardless of whether they have a clinical diagnosis of autism.
Background
Scurvy, the disease resulting from vitamin C deficiency, is perceived as being rare and occurring predominantly in the past. However, scurvy continues to exist and may be encountered in children with medical/developmental conditions and/or restricted diet. Diagnosis can be challenging given the perceived rarity of the condition and nonspecific symptoms, including gingival disease.
Methods
We present a series of two cases of scurvy in which the affected children presented to medical attention with dental complaints. Additional cases of scurvy are described, based on the literature review of case reports/series published in the last 10 years.
Results
Literature review yielded 77 relevant case reports published in the English language since 2009. Most affected children had a previous diagnosis of a medical or developmental condition (especially autism spectrum disorder). Intraoral features (gingival swelling, pain, and bleeding) were noted in most of the identified cases of scurvy. Improvement in the oral features of scurvy occurred within days of vitamin C therapy initiation.
Conclusions
Recognizing classic signs and symptoms of scurvy enables prompt diagnosis and avoids invasive investigations. Dentists may be in a unique position to facilitate prompt and accurate diagnosis of a condition that is relatively easy and safe to treat once identified.
Objective:
To document the clinical presentation of scurvy in children with autism spectrum disorder (ASD) and summarize the contemporary approaches to assessment and management in this population. Scurvy is a disease caused by vitamin C deficiency most often detected in populations at high risk for nutrition insufficiency (e.g., extreme poverty). Children with ASD and severe food selectivity consistent with avoidant-restrictive food intake disorder may also be at risk for scurvy.
Method:
We searched MEDLINE, CINAHL, and PsycINFO databases (1990-2018) in peer-reviewed journals for studies of children with ASD and scurvy. Inclusion criteria required confirmed diagnosis of ASD and scurvy in children (birth to 18 years) with a clear description of restrictive dietary patterns. Cases of scurvy due to other causes were excluded. We used a standardized protocol to independently code information; agreement between coders was high.
Results:
The systematic search identified 20 case reports involving 24 children (mean age = 9 ± 3.5; 22 boys/2 girls). The eventual diagnosis of scurvy followed a wide range of negative diagnostic testing; treatment with ascorbic acid and/or a multivitamin resulted in rapid improvement.
Conclusions:
Symptoms of scurvy mimic other pediatric conditions (e.g., cancer). The range of diagnostic testing increased costs and healthcare risks (radiation, sedation) and delayed the diagnosis of scurvy. In children with ASD and severe food selectivity, a nutrition evaluation and laboratory testing are warranted before a more elaborate testing.
