Escorbuto vs Reuma

December 30, 2019

Scurvy Can Be Mistaken for Rheumatologic Disorders

F. Bruder Stapleton, MD reviewing Perkins A et al. J Pediatr 2019 Dec 13

Dietary vitamin C deficiency was identified in 10 patients previously suspected to have juvenile idiopathic arthritis, vasculitis, or chronic nonbacterial osteomyelitis.

Scurvy is seldom suspected in children presenting with arthritis or extremity problems. A case series describes 10 children in Seattle (ages 3–20 years, 9 males) over 4 years who were found to have scurvy after referral to a rheumatology service for evaluation of lower extremity pain, limp, or refusal to bear weight. Among the findings:

• Other symptoms included ecchymoses (5 patients), petechiae, myalgias, polyarthralgia, gingivitis, epistaxis, sores in the mouth, anemia, and corkscrew hairs. One patient had arthritis.

• Reasons for referral were suspected juvenile idiopathic arthritis, vasculitis (Henoch-Schönlein purpura), and diffuse nonbacterial osteomyelitis.

• Eight patients had autism, developmental delay, or both. Most patients had limited diets that lacked fruits and vegetables.

• Erythrocyte sedimentation rate and C-reactive protein levels were elevated in 9 patients. Hematocrit values were low in all 10 patients; platelet counts were normal.

• In none of the diagnostic radiographs was scurvy offered as a potential diagnosis.

• Magnetic resonance imaging showed diffuse subperiosteal fluid edema. Scurvy was mentioned as a possibility in three of eight studies.

• Ascorbic acid levels were below normal in all in whom it was measured.

• Symptoms responded to supplemental vitamin C in all patients.

• Time to diagnosis ranged from 1 to 47 months.

COMMENT

These cases demonstrate that subpopulations of patients may have nutritional deficiencies and that scurvy can mimic inflammatory conditions. Taking dietary histories is important in all our patients; had that been done sooner, the patients in this report could have received a diagnosis sooner.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for F. Bruder Stapleton, MD at time of publication

Editorial Boards	UpToDate
Leadership Positions in Professional Societies	American Society of Pediatric Nephrology Foundation (Chair)

CITATION(S):

Perkins A et al. Scurvy masquerading as juvenile idiopathic arthritis or vasculitis with elevated inflammatory markers: A case series. J Pediatr 2019 Dec 13; S0022-3476(19)31470-2; [e-pub]. (https://doi.org/10.1016/j.jpeds.2019.10.059)

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