Scurvy in a Child with Autistic Spectrum Disorder (ASD)- A rare phenomenon presenting as a mimicker of debillitating diseases

Scurvy is a rare disease in developed countries. Risk groups include children with ristricted diets. Autistic children are picky eaters,sometimes to the extreme of FTT and unusual clinical presentation.

We present a 9.5 year old patient with autism admitted due to recent tip toe walking, pain in lower limbs, gradual immoblization and significant weight loss, acompanied by a worsening of a known eating disorders over the 6 weeks prior to admission..

Physical examination was unremarkable except for gingvitis, FTT(<3%ile), inability to walk or stand. muscle strength and bulk were intact as well his sensorium and deep tendon reflexes. Digital rectal exam was unremarkable

WorkUp : mildly elevated CRP 13, ESR 25, CPK 30, Vit D 8.5(low) folic acid 2.9(low), normal PTH, TSH and Calcium levels. normal CBC, serum Vit C level -pending.

chest and lower extremities Xray were unremarkable for osteopenia

Spine MRI - multiple focal B.M lesions involving thoracic & lumbar Vertebral bodies and pelvic bones. in proximity to growth plate of the sacroiliac & ischeal bones.Gadolinum showed enhancement of aforementioned lesion and adjacent soft tissues. raising a possible DDx of auto inflammatory multifocal osteomyelitis.

B.M Aspiration Biopsy - normal

NSAID treatment was inconclusive. A clinical diagnosis of Scurvy was made, and Oral Vit C and dietary supp. treating other nutritonal deficencies.Under this dietary regimn - immediate improvement in gingivitis, general apetite, increase with swift weight gain and gradual improvement with mobilitiy as well substantial decrease in pain.

Summary : Scurvy, though rare phenomnenon in developed countries, shoud be raised in the DD of the uncommon phenomenon of multifocal recurrent osteomyelitis, espcially when known eating disorders are noted, and clincal signs of vit C def. is evident