Scurvy Leaves a 12 Year Old Handicapped for Months.

Picture showing eruptions on the lower limbs (white arrow) and bleeding from the gums. Source: Paediatric Rheumatology.

This 12 year old Saudi child was already handicapped mentally. Scurvy turned him physically handicapped too.

In these modern times, doctors do not encounter a case of scurvy very often. And even if they do, they usually do not steer their diagnostics in that direction because vitamin C deficiency probably takes the last place on the list of nutritional deficiencies these days. Still, being uncommon should not put it entirely out of the equation. Here we describe the case of a 12 year old boy whose scurvy turned him listless; Rare upon Rare!

He presented to the clinic with musculoskeletal pains and skin eruptions. He would refuse to walk because of the pain and had remained motionless for 2 months. As for the eruptions, they had begun on the lower limbs five months ago. In spite of an initial treatment with prednisone, the eruptions never healed. In addition, the boy developed hemolytic anemia soon after the eruptions. Doctors gave him packed RBCs three times to restore his levels.

At his current presentation, he had a swollen leg. However, he did not have any history of trauma or fever. He also did not have any other typical symptoms of scurvy such as bleeding from the body orifices etc. The boy was negative for history of any prior respiratory, gastroenterology or genitourinary infections too.

Premature Birth and a Ton of Complications

The boy was born at 28 weeks of gestation as twins. Soon after his birth, doctors shifted him to neonatal ICU where he spent 2 months on assisted ventilation. He developed retinopathy of prematurity and understandably, prematurity took a toll on his mental development too.

On his current examination, doctors noticed a swelling on his left leg. Moreover, the boy constantly refused to walk and kept his leg fixed in a flexed position on a wheel chair. Because he felt pain, doctors did not assess his motor system. His skin showed multiple echymoses and purpura along with hyperkeratosis and bleeding gums Moreover, his left eye lacked red reflex indicative of retinopathy. His chest and CVS examinations however turned out normal.

Diagnostic Workup Reveals Scurvy

Doctors did a lot of investigations to thoroughly assess the patient under hematology, neurology and nutrition domains. Results revealed a decreased hemoglobin level consistent with patient’s ongoing hemolytic anemia. Thus, doctors quickly gave him packed RBCs transfusion to make up for the loss. Results showed a normal coagulation profile with adequate levels of factor 8 and 9 thereby excluding hemophilia. However nutritional studies revealed low levels of vitamin C. Based on deficiency of vitamin C together with bleeding gums and other features displayed by the boy, doctors finally made the diagnosis of scurvy.

Scurvy: What Do We Know About It?

Scurvy sets in due to deficiency of vitamin C, an essential micronutrient that must be supplied to the body via diet. Deficiency can occur due to either inadequate intake or improper absorption. Moreover when present, deficiency of Vitamin C is usually accompanied by a deficit of other nutrients too including iron and zinc. Anyhow, the disease shows both skin related and musculoskeletal manifestations. Most commonly it presents with swollen and bleeding gums along with petechiae and echymoses spread extensively across the body. Patients complain of myalgias and arthralgia and have a varying degree of anemia. They can also have swollen legs because of underlying hematomas. These collections of blood can involve both the bone (subperiosteal hematomas) and the muscles (muscular hematomas). The result nonetheless is the same; severe pain on movement and thereby restriction of mobility. As in our case, the patient remained motionless (unable to walk) for nearly two months.

Diagnosis and Treatment

Diagnosis for scurvy can be made by paying great attention to the patient’s sign and symptoms and history alone. Test are not required most of the times. However, other conditions such as hemophilia also present with bleeding tendencies and swollen joints (hemearthrosis). Thus to establish a conclusive diagnosis, tests play an important role. Blood tests will indicate anemia and can show slightly elevated ESR (but this does not mean that there is an inflammatory process). Coagulation profile will turn out normal for scurvy but not for hemophilia. Low levels of vitamin C on nutritional studies will confirm scurvy.

Treatment for scurvy is straight forward. Replenish what is lost. Supplementation with vitamin C reverses gingival bleeding and other constitutional symptoms within days. The musculoskeletal symptoms however can take a few weeks to revert. For our patient, doctors gave him vitamin C supplementation. Within four weeks, his symptoms resolved and his mobility improved as well. So much that he walked himself to the clinic for a follow-up session three months later.


Please enter your comment!
Please enter your name here