Doctors carried out a physical examination, blood tests and an MRI examination. Eventually, they consulted paediatric rheumatology and infectious diseases teams about the boy\u2019s condition.<\/p>\n
Restricted diet<\/p>\n
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.<\/p>\n
\u201cA detailed history revealed a diagnosis of autism with avoidant\/restricted food intake with a restricted diet consisting of solely chicken and biscuits \u2013 devoid of any vegetables or fruits,\u201d the report says.<\/p>\n
\u201cA presumed diagnosis of scurvy was made secondary to this restricted diet.\u201d<\/p>\n
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.<\/p>\n
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<\/p>\n
However, the boy\u2019s personal circumstances resulted in the disease being found here.<\/p>\n
\u201cScurvy is a rare condition caused by severe vitamin C deficiency characterised by gingival bleeding [bleeding gums], skin lesions, poor wound healing and bone abnormalities,\u201d the report says.<\/p>\n
\u201cAlthough rare in high-income countries, case studies have suggested it is not a historical disease.<\/p>\n
\u201cThis case demonstrates the importance of a dietary history as part of the clinical assessment \u2013 especially in at-risk populations with restricted eating, such as in patients with autism and in the hospitalised elderly.\u201d<\/p>\n
Antibiotics that had been given to the child were stopped and he was given regular feeding and vitamin supplementation.<\/p>\n
\u201cThe patient made a marked clinical improvement and was able to [move] after three to four days of inpatient therapy.\u201d<\/p>\n
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.<\/p>\n
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.<\/p>\n
They urged clinicians to consider vitamin C deficiency as a rare differential diagnosis in at-risk children \u2013 in this case, a child diagnosed with autism who had a severely restricted diet.<\/p>\n
\u201cThis case highlights that, although rare, scurvy should still be considered in New Zealand in at-risk populations.<\/p>\n
\u201cEarly identification and treatment should be instituted, as the treatment is relatively simple,\u201d they said.<\/p>\n
\u201cHowever, these vulnerable groups with food selectivity may require ongoing long-term nutritional supplementation to prevent recurrence.\u201d<\/p>\n