Nontypical presentation of scurvy in a previously healthy child without risk factors

Background: Scurvy has been reported to be the cause of death for about two million sailors between 1500 to 1700 AD. It is a disease caused by a prolonged deficiency in Vitamin C. It is an especially rare disease in children in developed countries. It often presents with irritability, failure to thrive, muscle/joint pain, and mucocutaneous features in infants and older children. A modern interest in the subject has risen due to an increase in reports of the disease in recent years. These cases are often of children with underlying medical conditions. Very few cases have been reported in otherwise healthy children. We report a rare case of scurvy in a previously healthy 3-year-old patient from a middle-class family who presented without mucosal bleeding or odd dietary habits. Case information: A previously healthy 3-year-old male presented to rheumatology clinic for evaluation of a limp. He had no prior hospitalizations or surgeries, and had no chronic medical problems. Mom reported a development of a nonspecific limp and a refusal to jump that began three months prior to presentation. Physical exam revealed full range of motion of all joints without swelling or tenderness. He had no epistaxis, gingival bleeding, or petechiae. Patient had extensive workup done to rule out malignancies and autoimmune disorders. Post-streptococcal glomerulonephritis, inflammatory arthropathy, axial spondyloarthropathy, leukemia, and chronic recurrent multifocal osteomyelitis were all considered during the workup for this patient due to the atypical patient presentation and nonspecific lab findings. The x-ray of the leg showed some stress fractures which raised concerns for possible vitamin deficiency. Labs showed low vitamin D levels and Vitamin C levels. A diagnosis of scurvy was made. Patient was placed on vitamin C and D supplements with rapid improvement in his condition. Conclusion: Scurvy can have a vague presentation and can often mimic other diseases such as malignancies, osteomyelitis, septic arthritis, rheumatologic conditions, and bleeding disorders. Because of its rarity in America, a nontypical case can make it very challenging to derive this diagnosis. Although cases of scurvy in patients without underlying medical conditions have been reported, the lack of gingival and skin findings and odd nutritional habits make this a very rare and unusual case.