Luckow Christopher, Thomas Anita A
Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.
Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.
J Emerg Med. 2021 Mar;60(3):e53-e56. doi: 10.1016/j.jemermed.2020.09.036. Epub 2020 Oct 24.
Limping is a common chief complaint in the pediatric emergency department (ED) and can be difficult to assess in pediatric patients, particularly if they have developmental delay.
We present a case of a 5-year-old male with nonverbal autism who presented with a progressive limp, weakness, pain, and rash over the course of 1 month. A magnetic resonance imaging scan of the pelvis performed while the patient was sedated revealed multifocal osseous marrow signal abnormalities, ultimately consistent with vitamin C deficiency or scurvy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Scurvy can present with nonspecific limp, rash, and bony pain and should be considered in pediatric patients with developmental/sensory delay who may restrict their diets. Emergency physicians should broaden their differential diagnoses to nutritional deficiencies such as scurvy in the evaluation of pediatric patients with limp.
跛行是儿科急诊科常见的主要症状，对于儿科患者，尤其是发育迟缓的患者，评估起来可能较为困难。
我们报告一例5岁男性非言语型自闭症患者，在1个月内出现进行性跛行、虚弱、疼痛和皮疹。在患者镇静状态下进行的骨盆磁共振成像扫描显示多灶性骨髓信号异常，最终确诊为维生素C缺乏或坏血病。
为什么急诊医生应该了解这个病例？：坏血病可能表现为非特异性跛行、皮疹和骨痛，对于饮食可能受限的发育/感觉迟缓的儿科患者应考虑该病。在评估儿科跛行患者时，急诊医生应拓宽鉴别诊断范围，将坏血病等营养缺乏症纳入考虑。
