A recent review published in JAAOS: Global Research and Reviews has provided comprehensive information on the symptoms, diagnosis, radiological evidence, and treatment of scurvy, a disease that can be relatively common among individuals with an especially severe vitamin C (i.e., ascorbic acid) deficiency. The team conducted a retrospective investigation of pediatric patients from the United States National Inpatient Sample Database, covering a substantial sample size of 19,413,465 patients between 2016 and 2020. The findings revealed pediatric scurvy has more than tripled in just five years, going from 8.2 to 26.7 cases per 100,000 children.Vitamin C is necessary for collagen synthesis and iron absorption. Scurvy occurs when there is a significant deficiency of this vitamin, generally due to not having nutritional needs met, and has historically been common among sailors and individuals with limited access to fresh fruits and vegetables. It can lead to petechiae (small round spots on the skin), bone pain, gum bleeding, and iron-deficiency anemia. In pediatric populations, the condition can manifest as false (pseudo) paralysis, swollen joints, rotated knee or ankle joints, and musculoskeletal conditions, such as juvenile idiopathic arthritis, bone tumors, and septic arthritis. Radiographic evidence is usually performed to diagnose the condition.Studies have drawn attention to the resurgence of pediatric scurvy even in developed countries, linking this to poor diet choices, autism spectrum disorder (ASD), and low socioeconomic status. The current study revealed that more than half (64.2%) of the scurvy patients also have ASD, and the highest-risk population included male obese individuals, particularly those who are considered low-income. Despite its severe physical effects, scurvy is easily treatable with certain dietary changes and vitamin C supplements (100-300 mg per day for children and 500-1000 mg per day for adults).

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“Scurvy is frequently not included in the differential diagnoses for pediatric musculoskeletal complaints, leading to delayed diagnosis, increased morbidity, and unnecessary, costly testing,” the researchers noted in their paper.The study concluded that the rising number of cases in the U.S. call for increased awareness among pediatricians and caregivers to include scurvy in differential (alternate) diagnoses when patients present with symptoms common among those with scurvy. There are many other health conditions that present with similar symptoms, including:Juvenile Idiopathic Arthritis (JIA): presents with joint pain, swelling, and stiffness.Septic Arthritis: This infection can lead to joint swelling, pain, and a fever.Bone Tumors: Tumors such as osteosarcoma can cause bone pain, swelling, and abnormal bone growth.Rickets: Caused by vitamin D deficiency, the condition can lead to bone pain and deformities similar to scurvy.Sickle Cell Disease: the disease can cause extreme pain, bone problems, and swelling.Osteomyelitis: Osteomyelitis can cause bone pain and swelling.Hemophilia: This bleeding disorder can lead to easy bruising and bleeding, including petechiae.The ability to rule out the above and arrive at an accurate diagnosis can save lives in a pediatric population – a very vulnerable group – by catching and correcting the condition early on.

Sources:

Scurvy on the rise in the United States: Pediatric cases triple in five yearsThe Troubling Rise of Scurvy: A Review and National Analysis of Incidence, Associated Risk Factors, and Clinical ManifestationsScurvy and its prevention and control in major emergenciesPediatric Scurvy: How an Old Disease Is Becoming a New Problem