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小儿坏血病:当代饮食习惯重现过往病症

Pediatric Scurvy: When Contemporary Eating Habits Bring Back the Past.

作者信息

Brambilla Alice, Pizza Cristina, Lasagni Donatella, Lachina Lucia, Resti Massimo, Trapani Sandra

机构信息

Pediatric Department, University of Florence, Anna Meyer Children Hospital, Florence, Italy.

Clinical Pediatric Department, Anna Meyer Children Hospital, Florence, Italy.

出版信息

Front Pediatr. 2018 May 1;6:126. doi: 10.3389/fped.2018.00126. eCollection 2018.

Abstract

Vitamin C deficiency is anecdotal in developed countries, mainly associated with underling clinical morbidities as autism or neurological impairment. Chronic insufficient dietary supply is responsible for vascular fragility and impaired bone formation, resulting in gingival bleeding, petechial lesions, articular and bone pain or limb swelling. Children may present anorexia, irritability, failure to thrive, limping or refusal to walk. Accordingly, pediatric scurvy is frequently misdiagnosed with osteomyelitis, septic arthritis, bone and soft tissue tumor, leukemia, bleeding disorders, and rheumatologic conditions. We report the case of a 3-years old child developing scurvy as consequence of strict selective diet; extensive and invasive investigations were undertaken before the correct diagnosis was considered. Despite being considered a rare condition, scurvy still exists nowadays, even in children with no apparent risk factors living in wealthy families. The increasing popularity of dietary restriction for children, especially those with allergies, may potentially enhance the occurrence of scurvy in apparently healthy children. Appropriate dietary anamnesis is fundamental in order to highlight potential nutritional deficit and to avoid unnecessary invasive diagnostic procedures. Patients without considerable risk factors may benefit from psychological support in order to investigate possible eating disorders.

摘要

在发达国家,维生素C缺乏症多为传闻,主要与诸如自闭症或神经损伤等潜在临床疾病相关。长期饮食供应不足会导致血管脆弱和骨形成受损,进而引发牙龈出血、瘀点性病变、关节和骨骼疼痛或肢体肿胀。儿童可能出现厌食、易怒、发育不良、跛行或不愿行走。因此,小儿坏血病常被误诊为骨髓炎、化脓性关节炎、骨与软组织肿瘤、白血病、出血性疾病和风湿性疾病。我们报告了一例3岁儿童因严格的选择性饮食而患坏血病的病例;在考虑正确诊断之前进行了广泛的侵入性检查。尽管坏血病被认为是一种罕见疾病,但如今仍然存在,即使在没有明显风险因素的富裕家庭儿童中也是如此。对儿童,尤其是对有过敏症儿童进行饮食限制的情况日益普遍,这可能会增加看似健康儿童患坏血病的几率。适当的饮食问诊对于发现潜在的营养缺乏以及避免不必要的侵入性诊断程序至关重要。没有明显风险因素的患者可能会受益于心理支持,以便调查可能存在的饮食失调问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b8c/5946015/ecaf1b9fe570/fped-06-00126-g0001.jpg

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