Lund Robin M, Becker Mara L, Shapiro Steven, Allison Tyler, Harris Julia G
University of Louisville School of Medicine, 571 S. Floyd Street, Suite 412, Louisville, KY, 40202, USA.
Duke Clinical Research Institute, 200 Morris Street, Durham, North Carolina, 27701, USA.
BMC Pediatr. 2019 Jul 6;19(1):228. doi: 10.1186/s12887-019-1605-5.
Scurvy is one of the oldest diseases known to mankind. Although presently rare in the developed world, scurvy was a common potentially fatal disease. In recent times, the most common risk factors for scurvy include alcoholism, low socioeconomic status, and severely poor nutrition or dietary restriction secondary to psychiatric illness or developmental disorders. Our case demonstrates the importance of having a high index of clinical suspicion of an uncommon disease in developed countries and emphasizes the necessity of a dietary screening that could potentially reduce extensive work-up in patients with nonspecific complaints.
We report a case of a 3-year-old previously healthy female originally seen in the rheumatology clinic for limp. She developed weakness and was admitted to the hospital for further evaluation. She underwent extensive diagnostic testing including blood work, magnetic resonance imaging, lumbar puncture, electromyogram, and nerve conduction studies. Ultimately, her vitamin C level returned undetectable. She had immediate and complete improvement upon starting vitamin C supplementation.
Despite being developmentally appropriate, our patient's refusal to eat fruits or vegetables had limited her diet, emphasizing the importance of obtaining a diet history in a child presenting with an unknown diagnosis. In addition, our patient had no other characteristic features of scurvy, which further supports the need to consider this diagnosis in a child presenting with lower extremity weakness or abnormal gait.
坏血病是人类已知的最古老疾病之一。尽管目前在发达国家已较为罕见，但坏血病曾是一种常见的潜在致命疾病。近来，坏血病最常见的风险因素包括酗酒、社会经济地位低下以及继发于精神疾病或发育障碍的严重营养不良或饮食限制。我们的病例表明，在发达国家对罕见疾病保持高度临床怀疑的重要性，并强调了进行饮食筛查的必要性，这可能会减少对有非特异性症状患者的广泛检查。
我们报告一例3岁以前健康的女性病例，最初因跛行就诊于风湿病诊所。她出现了虚弱症状并被收入院进一步评估。她接受了广泛的诊断检查，包括血液检查、磁共振成像、腰椎穿刺、肌电图和神经传导研究。最终，她的维生素C水平检测不到。开始补充维生素C后，她立即完全康复。
尽管发育正常，但我们的患者拒绝吃水果或蔬菜限制了她的饮食，这强调了在诊断不明的儿童中获取饮食史的重要性。此外，我们的患者没有坏血病的其他特征性表现，这进一步支持了在出现下肢无力或异常步态的儿童中考虑这一诊断的必要性。
