Scurvy in pediatric age group - A disease often forgotten?

Abstract

Scurvy is caused by prolonged severe dietary deficiency of vitamin C. Being rare as compared to other nutritional deficiencies, it is seldom suspected and this frequently leads to delayed recognition of this disorder. Children with abnormal dietary habits, mental illness or physical disabilities are prone to develop this disease. The disease spectrum of scurvy is quite varied and includes dermatological, dental, bone and systemic manifestations. Subperiosteal hematoma, ring epiphysis, metaphyseal white line and rarefaction zone along with epiphyseal slips are common radiological findings. High index of suspicion, detailed history and bilateral limb radiographs aids physician in diagnosing this eternal masquerader. We searched Pubmed for recent literature (2009-2014) with search terms "scurvy" "vitamin C deficiency" "ascorbic acid deficiency" "scurvy and children" "scurvy and pediatric age group". There were a total of 36 articles relevant to pediatric scurvy in children (7 reviews and 29 case reports) which were retrieved. The review briefly recapitulates the role of vitamin C, the various disease manifestations and the treatment of scurvy to create awareness of the disease which still is reported from our country, although sporadically. The recent advances related to scurvy and its management in pediatric age group are also incorporated.

Keywords: Ascorbic acid; Children; Pediatric age group; Scurvy; Vitamin C.

Fig. 1

Clinical photograph showing inflammed marginal gingiva in scurvy.

Fig. 2

Clinical spectrum of scurvy is discrete and patients can presented with isolated clinical findings.

Fig. 3

Drawing showing (A) pithed frog, (B) child in pithed frog posture.

Fig. 4

Radiographs of right thigh showing (A) lower femoral epiphyseal slip. Subperiosteal hematoma was not visible initially, (B) subperiosteal hematoma (in healing stage) after treatment was initiated, (C) final radiographs after completion of treatment.

Fig. 5

Drawing showing radiological signs in scurvy.

Fig. 6

Radiographs of the both knee showing (A) pencil thin cortex, (B) pelkan spurs, (C) Fraenkel line, (D) ring epiphysis. The radiographs show a washed out appearance.