No longer a historical ailment: two cases of childhood scurvy with recommendations for bone health providers

• Published in: Osteoporosis international Vol. 31; no. 5; pp. 1001 - 1005
• Main Authors: Alten, E.D., Chaturvedi, A., Cullimore, M., Fallon, A.A., Habben, L., Hughes, I., O’Malley, N.T., Rahimi, H., Renodin-Mead, D., Schmidt, B.L., Weinberg, G.A., Weber, D.R.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.05.2020; Springer Nature B.V
• Subjects: Anemia; Ascorbic acid; Ascorbic Acid - therapeutic use; Bone Density; Bone growth; Bone imaging; Bone marrow; Case Report; Case reports; Child; Child, Preschool; Children; Collagen; Diagnosis; Endochondral bone; Endocrinology; Epilepsy; Female; High fat diet; Humans; Immobilization; Inflammation; Ketogenesis; Low carbohydrate diet; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Nutrient deficiency; Orthopedics; Osteogenesis; Rheumatology; Scurvy - complications; Scurvy - diagnosis; Scurvy - drug therapy; Vitamin C; Vitamins; Magnetic resonance imaging; Vitamin C deficiency; Scurvy; Avoidant restrictive food intake disorder; Ketogenic diet; Osteopenia
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-019-05264-4

Purpose Scurvy, due to vitamin C deficiency, is commonly referenced as a “forgotten” or “historical” disease. A growing number of case reports challenge this notion. Bone health providers are often consulted early in the presentation of scurvy to evaluate musculoskeletal complaints resulting from impaired collagen production and disrupted endochondral bone formation. In this report, we describe two cases of childhood scurvy. Our objective is to summarize the key features of scurvy for bone health providers, with the goal of raising awareness and facilitating diagnosis in future cases. Case descriptions Case one occurred in a 12-year-old non-verbal, non-ambulatory female on a ketogenic diet for refractory epilepsy. Clinical findings included hemarthrosis, transfusion dependent anemia, elevated inflammatory markers, and epiphysiolysis. Magnetic resonance imaging (MRI) revealed multi-focal bone marrow signal abnormalities and physeal irregularities. Case two occurred in a typically developing 5-year-old male presenting with limp and knee pain. Symptoms progressed despite casting and immobilization. Mild anemia, elevated inflammatory markers, and multi-focal marrow and physeal MRI abnormalities were identified. Subsequent dietary history revealed total absence of fruit or vegetable consumption. The diagnosis of scurvy was confirmed in both cases by undetectable plasma vitamin C concentrations. Treatment with vitamin C led to rapid clinical improvement. Conclusion Scurvy can no longer be considered a historical diagnosis and should not be forgotten when evaluating children with musculoskeletal ailments. Early recognition of the signs, symptoms, and imaging findings of scurvy can reduce the clinical burden of this disease with the timely initiation of vitamin C therapy.