A Case Report

Scurvy May Occur Even in Children With No Underlying Risk Factors

Romina Gallizzi; Mariella Valenzise; Stefano Passanisi; Giovanni Battista Pajno; Filippo De Luca; Giuseppina Zirilli

J Med Case Reports. 2020;14(18)

Conclusions

Nowadays scurvy is a rare condition in industrialized countries and mainly appears in patients affected by underlying chronic disease. However, some case reports of apparent healthy children who developed scurvy have been reported in the literature over the last years. We point out the essential role of pediatricians in the eating habits of preschool children. The adoption of a detailed dietary anamnesis is fundamental to the early recognition of nutritional deficiency diseases and to avoid the performing of invasive procedures and/or their severe complications.

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Abbreviations
1,25-OH-vitamin D: 1,25-hydroxyvitamin D; 25-OH-vitamin D: 25-hydroxyvitamin D

Acknowledgements
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Consent for publication
Written informed consent was obtained from the patient's parents for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Table 1. Specific nutritive intake of our patient* and recommended intake for age ^§
	Vitamin C	Vitamin D	Iron
Milk (3 cups daily)	7.5 mg	unknown	1.5 mg
Pasta (120 g daily)	0	0	0.8 mg
Daily recommended nutrient intake for age	35 mg	15 μg	8 mg

*According to the data of Reference [19]
^§According to the recommendations of Reference [20]

Table 2. Results of patient's laboratory tests
Date	Laboratory test	Patient's value	Reference range*
22 Jul	Hemoglobin (g/L)	5.4	11–15
22 Jul	Red blood cell count (× 10¹²/L)	1.92	3.5–4.5
22 Jul	Reticulocyte count (%)	3.5	0.5–2.5
22 Jul	White blood cell count (× 10⁹/L)	8.75	6–12
22 Jul	Neutrophil count (%)	54	60–70
22 Jul	Lymphocyte count (%)	40	20–35
22 Jul	Platelet count (×10⁹/L)	369	150–350
22 Jul	Activated partial thromboplastin time (seconds)	30.2	21–35
22 Jul	Plasma fibrinogen (g/L)	2.79	2–4
22 Jul	Prothrombin (%)	71	70–120
22 Jul	Creatine phosphokinase (U/L)	43	0–200
22 Jul	Lactate dehydrogenase (U/L)	432	150–460
22 Jul	Alanine transaminase (U/L)	12	0–50
22 Jul	Aspartate transaminase (U/L)	31	0–42
22 Jul	Creatinine (mg/dl)	0.2	< 1.2
22 Jul	Blood urea nitrogen (mg/dl)	18.5	0–20
22 Jul	Iron (μmol/L)	2.1	9–27
22 Jul	Ferritin (μg/L)	9.6	22–400
22 Jul	C-reactive protein (mg/L)	4.2	0–5
24 Jul	Ascorbic acid (μmol/L)	< 5	11–85
24 Jul	25-OH-vitamin D (nmol/L)	17	25–90
24 Jul	1,25-OH-vitamin D (pmol/L)	35	40–140

1,25-OH-vitamin D 1,25-hydroxyvitamin D, 25-OH-vitamin D 25-hydroxyvitamin D, * for our hospital laboratory

Table 3. Timeline of medical history and interventions
	Summaries from initial and follow-up visits	Diagnostic testing	Interventions
T = 0 (20 Jul–2 Aug)	Physical examination: severe pallor, petechial hemorrhages on arms and legs, gum hypertrophy and bleeding, macroscopic hematochezia, and, finally, tachycardia and dyspnea. No evidence of hepatosplenomegaly or lymphadenopathies or joint effusions	Leg X-ray (21 Jul): dense lines at the distal right femoral metaphysis and a lucent metaphyseal band Laboratory tests (22–24 Jul): severe anemia, low levels of iron, ferritin, ascorbic acid, 25-OH-vitamin D, and 1,25-OH-vitamin D	Vitamin C supplementation was practiced, starting from 300 mg/day for 28 days, followed by 100 mg/day in maintaining phase. Introduction of fruit and vegetables in the child's diet
T = 3 months (3 Nov)	Physical examination: good clinical state. No cutaneous or mucosal alterations. Resolution of limping	Laboratory tests: normal value of hemoglobin (12.6 g/dl) and ascorbic acid (59 μmol/L) Leg X-ray: no radiological anomalies	Suspension of any treatment

1,25-OH-vitamin D 1,25-hydroxyvitamin D, 25-OH-vitamin D 25-hydroxyvitamin D

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Scurvy May Occur Even in Children With No Underlying Risk Factors

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