Clinical, laboratory, radiologic and ex juvantibus diagnosis of pediatric scurvy: A case report

This case report highlighted diagnosis of pediatric scurvy from clinical, laboratory, radiologic examination and excellent response after vitamin C supplementation. A 3-years-old boy presented with painful edematous knees and feet and pseudoparalysis for 2 months, palpable perifollicular petechiae and corkscrew hairs on legs for 11 days and petechiae on feet and edematous easily-bleeding gums for 3 days. His diet lacked fruits and vegetables. Laboratory investigations showed anemia, elevated erythrocyte sedimentation rate, decreased iron and hematuria. Plain radiograph of knees showed osteopenia and joint effusion. Initial diagnosis made was cutaneous vasculitis. Complaints persisted despite treatment with ibuprofen and prednisone, but improved rapidly after vitamin C supplementation. Histopathology of skin lesion showed no vasculitis. Final diagnosis of scurvy was made. Vitamin C supplementation was continued which led to resolution and no recurrence of signs and symptoms. Prominent musculoskeletal findings and vasculitis-like skin lesions often cause misdiagnosis of pediatric scurvy. Perifollicular petechiae, corkscrew hairs, gingival edema, and dietary history are clues for scurvy. Diagnosis of scurvy can be established by clinical and supporting examination, or in ex juvantibus, when ascorbic acid level measurement is unavailable.