Article Text

SCURVY IN THE UNITED KINGDOM: FORGOTTEN BUT STILL PRESENT
  1. M A Anjay1,
  2. V Palanivel1,
  3. R Chaudhary1,
  4. R Stocks1
  1. 1Department of Paediatrics, James Paget University Hospital, Great Yarmouth, Norfolk, UK

Abstract

Objective We present a case of scurvy in a child with cerebral palsy.

Methods Case report.

Results A 6 years old girl known to have cerebral palsy with right hemiparesis presented with right leg pain and inability to bear weight for a few weeks. She was described as a ‘fussy’ eater. On examination, there was swelling of the right knee with reduced range of movements. A few petechiae were noticed over both legs and the gums. Blood tests showed mild anaemia. The x ray of her right knee showed osteopenia with thin cortex, calcification around the epiphysis and a small bony spur which are classical features of scurvy. Ultrasound of the right knee revealed an effusion with periosteitis. MRI scan showed extensive subperiosteal fluid along the femoral shaft, which supported the diagnosis. She was managed with vitamin C supplementation and is making good recovery.

Conclusions Scurvy is an extremely rare disease in the western world. It has occasionally been reported in debilitated elderly patients and alcoholics. However it is virtually unheard of in children. We report this as the first case of scurvy in a child from the UK in recent years. As shown in our case, children with chronic illnesses, particularly neurodisability are at higher risk of developing vitamin deficiencies including vitamin C. Most clinicians and radiologists in the modern era may not be aware of the clinical features of this condition. Although rare, it is still present and a high index of suspicion is required for early intervention.

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