Doctors carried out a physical examination, blood tests and an MRI examination. Eventually, they consulted paediatric rheumatology and infectious diseases teams about the boy’s condition.
Restricted diet
More tests found the boy had swollen, bleeding gums and a faint rash on his lower legs. Further blood tests focusing on nutritional deficiencies returned low vitamin C in the boy.
“A detailed history revealed a diagnosis of autism with avoidant/restricted food intake with a restricted diet consisting of solely chicken and biscuits – devoid of any vegetables or fruits,” the report says.
“A presumed diagnosis of scurvy was made secondary to this restricted diet.”
Scurvy is often thought of as a historical disease, particularly in the 15th to 18th centuries, and is associated with sailors who spent long periods at sea and went without fresh foods or produce.
Experts say the boy’s case highlights that, although rare, scurvy should still be considered in New Zealand in at-risk populations. Photo / NZ Medical Journal
However, the boy’s personal circumstances resulted in the disease being found here.
“Scurvy is a rare condition caused by severe vitamin C deficiency characterised by gingival bleeding [bleeding gums], skin lesions, poor wound healing and bone abnormalities,” the report says.
“Although rare in high-income countries, case studies have suggested it is not a historical disease.
“This case demonstrates the importance of a dietary history as part of the clinical assessment – especially in at-risk populations with restricted eating, such as in patients with autism and in the hospitalised elderly.”
Antibiotics that had been given to the child were stopped and he was given regular feeding and vitamin supplementation.
“The patient made a marked clinical improvement and was able to [move] after three to four days of inpatient therapy.”
The boy was later discharged with community nursing and dietitian follow-up appointments; with subsequent clinic reviews showing clearing of the rash in his legs and improvement with mobility.
The authors of the report, orthopaedic registrars Weisi Xia and Michaela Mullen, and orthopaedic surgeon Ryan Johnstone, work in the Department of Orthopaedic Surgery at Hutt Valley Hospital in Wellington.
They urged clinicians to consider vitamin C deficiency as a rare differential diagnosis in at-risk children – in this case, a child diagnosed with autism who had a severely restricted diet.
“This case highlights that, although rare, scurvy should still be considered in New Zealand in at-risk populations.
“Early identification and treatment should be instituted, as the treatment is relatively simple,” they said.
“However, these vulnerable groups with food selectivity may require ongoing long-term nutritional supplementation to prevent recurrence.”
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