Clinical, Laboratory, Radiologic and Ex Juvantibus Diagnosis of Pediatric Scurvy
Diagnosis of Pediatric Scurvy
DOI:
https://doi.org/10.66344/jpad.v32i3.1989Abstract
This case report highlighted diagnosis of pediatric scurvy from clinical, laboratory, radiologic examination and excellent response after vitamin C supplementation. A 3-years-old boy presented with painful edematous knees and feet and pseudoparalysis for 2 months, palpable perifollicular petechiae and corkscrew hairs on legs for 11 days and petechiae on feet and edematous easily-bleeding gums for 3 days. His diet lacked fruits and vegetables. Laboratory investigations showed anemia, elevated erythrocyte sedimentation rate, decreased iron and hematuria. Plain radiograph of knees showed osteopenia and joint effusion. Initial diagnosis made was cutaneous vasculitis. Complaints persisted despite treatment with ibuprofen and prednisone, but improved rapidly after vitamin C supplementation. Histopathology of skin lesion showed no vasculitis. Final diagnosis of scurvy was made. Vitamin C supplementation was continued which led to resolution and no recurrence of signs and symptoms. Prominent musculoskeletal findings and vasculitis-like skin lesions often cause misdiagnosis of pediatric scurvy. Perifollicular petechiae, corkscrew hairs, gingival edema, and dietary history are clues for scurvy. Diagnosis of scurvy can be established by clinical and supporting examination, or in ex juvantibus, when ascorbic acid level measurement is unavailable.
References
1. Agarwal A, Shaharyar A, Kumar A, et al. Scurvy in pediatric age group - A disease often forgotten? J Clin Orthop Trauma. 2015;6(2):101–7.
2. Vaezipour N, Leibundgut K. Nonalimental scurvy with relapse symptoms after stopping oral Vitamin C supplementation. Pediatrics. 2018;142(2):e20172139.
3. Brambilla A, Pizza C, Lasagni D, et al. Pediatric scurvy: When contemporary eating habits bring back the past. Front Pediatr. 2018;6(May):1–4.
4. Miraj F, Abdullah A. Scurvy: Forgotten diagnosis, but still exist. Int J Surg Case Rep. 2020;68(18):263–6.
5. Choh CTP, Rai S, Abdelhamid M, et al. Unrecognised scurvy. BMJ. 2010;340(7738):150–1.
6. Roy-Lavallee J, Bahrani B, Weinstein M, et al. Scurvy: An Unexpected Nutritional Complication in an Adolescent Female With Anorexia Nervosa. J Adolesc Heal. 2020;67(4):618–20.
7. Tee JL, Strutton G. Keratosis pilaris with adjacent haemosiderin deposition: a clue to scurvy. Pathology. 2021;53(5):666–8.
8. Hidayati AN, Purnamasari I, Hartanto F, et al. Herpes zoster in COVID-19 patient: A coexistence or coincidence? Malaysian J Med Heal Sci. 2021;17(June):182–4.
9. Prameswari R, Indramaya DM, Sawitri. Haemorrhagic Bullous Lesion in Henoch-Schonlein Purpura. Berk Ilmu Kesehat Kulit dan Kelamin Period Dermatology Venereol. 2016;28(2):83–9.
10. Hidayati AN. Manifestasi Kelainan Dermatologi Terkait Covid-19. In: Hidayati AN, Suryantoro SD, Rosyid AN, et al., editors. Covid-19: Tinjauan Komprehensif dan Multidisiplin. Surabaya: Airlangga University Press; 2022. 237–66.
11. Gunawan PI, Saharso D. A case of juvenile dermatomyositis responding to methotrexate and steroid. Bangladesh J Med Sci. 2018;17(4):675–7.
12. Gunawan PI, Saharso D. Paediatrica Indonesiana. Paediatr Indones. 2007;47(5):244–6.
13. Tunjungsari DA, Gunawan PI, Ugrasena IDG. Risk factors of vincristine-induced peripheral neuropathy in acute lymphoblastic leukaemia children. J Med Investig. 2021;68:232–7.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Sawitri, Afif Nurul Hidayati, Lunardi Bintanjoyo, Prastiya Indra Gunawan, Riza Noviandi, Yuri Widia, Irmadita Citrashanty, Iskandar Zulkarnain
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
