PEDIATRICS Vol. 108 No. 3
September 2001,
p. e55
ELECTRONIC ARTICLE:
An Orange a Day Keeps the Doctor Away: Scurvy in the Year 2000
Received Mar 8, 2001; accepted May 8, 2001.
Michael Weinstein*,
Paul Babyn
, and
Stan Zlotkin*
From the Departments of * Paediatrics and Radiology, Hospital
for Sick Children and University of Toronto, Toronto, Canada.
Scurvy has been known since ancient times, but the
discovery of the link between the dietary deficiency of ascorbic acid
and scurvy has dramatically reduced its incidence over the past
half-century. Sporadic reports of scurvy still occur, primarily in
elderly, isolated individuals with alcoholism. The incidence of scurvy in the pediatric population is very uncommon, and it is usually seen in
children with severely restricted diets attributable to psychiatric or
developmental problems. The condition is characterized by
perifollicular petechiae and bruising, gingival inflammation and
bleeding, and, in children, bone disease. We describe a case of scurvy
in a 9-year-old developmentally delayed girl who had a diet markedly
deficient in vitamin C resulting from extremely limited food
preferences. She presented with debilitating bone pain, inflammatory
gingival disease, perifollicular hyperkeratosis, and purpura. Severe
hypertension without another apparent secondary cause was also present,
which has been previously undescribed. The signs of scurvy and
hypertension resolved after treatment with vitamin C. The diagnosis of
scurvy is made on clinical and radiographic grounds, and may be
supported by finding reduced levels of vitamin C in serum or buffy-coat
leukocytes. The response to vitamin C is dramatic. Clinicians should be
aware of this potentially fatal but easily curable condition that is
still occasionally encountered among children.
Key words:
scurvy,
hypertension,
magnetic resonance imaging,
bone pain.
