A previously healthy 3 years old girl was reffered to our ER with intermittent six months history of leg pain and a three weeks history of gradual inability to bear weight on her legs.
On examination she was afebrile. both legs were diffusely tender to palpitation. She had swollen gingiva and Scattered petechiae on her lower extremities. the remainder of her physical examination was normal. A complete blood count, peripheral blood smear, coagulation times and blood chemistry test results were normal. Radiographs of lower extremities were normal. On bone scan increased uptake was seen over the left proximal tibia. MRI of lower extremities showed metaphyseal bone marrow infiltration and periosteal elevation in both knees and ankles. A possible diagnosis of scurvy was considered. A review of the patient dietary history revealed a very selective diet. her parent described her as picky eater. Blood levels of Vitamin c were taken and intravenous treatment with ascorbic acid was initiate for a week and continued orally. The girl gradually improved clinically with return to her normal gait in one week. Blood levels of Vitamin C returned very low.
Although rare, scurvy has been reported mostly in children with medical background, psychiatric or developmental delay. It is important to keep in mind that it could be diagnosed in healthy children with unusual eating habits like a "picky eater child". A high index awareness is needed to avoid unnecessary tests and procedures and to be able to treat a potentially fatal but easily curable disease.
