Department of Pediatrics, Assuta Ashdod Hospital, Ashdod, Israel.
Pediatric Orthopedics Unit, Assuta Ashdod Hospital, Ashdod, Israel.
Nutrition. 2021 Feb;82:111019. doi: 10.1016/j.nut.2020.111019. Epub 2020 Sep 9.
We present a case of an otherwise healthy 3-year-old child who presented with limping, bone pain, fatigue, and agitation. Differential diagnosis included an infection of the bone, malignancy, an inflammatory bone disease, and metabolic bone disease. Magnetic resonance imaging of the lower limbs and the spine was consistent with scurvy, and the diagnosis was confirmed by very low levels of vitamin C. Further history taking revealed a diet based entirely on dairy pudding, with no fruits or vegetables, and being a "picky eater" was the sole reason. Intravenous treatment with vitamin C led to full recovery. Previous reports of scurvy were in patients with other medical conditions, such as malabsorption, or behavioral conditions as in autism. This case demonstrates that scurvy, an almost forgotten condition from past centuries, can occur in otherwise healthy children and should raise awareness regarding the importance of a balanced diet and proper nutritional history taking. Following growth charts as the only screening tool for balanced and inclusive nutrition may not be sufficient.
我们报告了一例无其他健康问题的 3 岁儿童,其主要表现为跛行、骨痛、疲劳和烦躁。鉴别诊断包括骨感染、恶性肿瘤、炎性骨病和代谢性骨病。下肢和脊柱的磁共振成像符合坏血病,维生素 C 水平极低证实了这一诊断。进一步的病史询问发现,患儿的饮食完全基于乳布丁,没有水果或蔬菜,而挑食是唯一的原因。静脉注射维生素 C 治疗后完全康复。以前有关坏血病的报告见于有其他医疗条件的患者,如吸收不良,或自闭症等行为疾病。本病例表明,坏血病这种来自过去几个世纪的几乎被遗忘的疾病,可能发生在其他健康的儿童身上,这应该引起人们对均衡饮食和适当营养史询问的重要性的认识。仅仅依靠生长图表作为均衡和全面营养的唯一筛查工具可能是不够的。