(P08-007-23) Case Series: What We C in Pediatric Patients with Scurvy

Objectives: Food selectivity in children with neurodevelopmental disorders or other causes of dietary restriction can lead to complete absence of vitamin C intake and development of scurvy. We aimed to characterize pediatric patients diagnosed with ascorbic acid deficiency.

Methods: We conducted a retrospective chart review at one academic children’s hospital for patients over 1 year old with ICD9/10 codes for vitamin C deficiency, ascorbic acid deficiency or scurvy from 2003-2022. Medical records were reviewed by two individuals to identify presenting symptoms, past medical history, diet, ascorbic acid level, and imaging. Patients were excluded if the diagnosis was not confirmed by serum ascorbic acid level, dietary recall with limited to no vitamin C intake, or no clinical improvement with vitamin C supplementation.

Results: Of the 56 patients identified by ICD 9/10 codes, 47 had confirmed diagnosis of scurvy. 17 were female and 26 were non-Hispanic white. Age at diagnosis ranged from 13 mo to 25 yr. 23 patients (49%) had a diagnosis of autism spectrum disorder (n = 18) or other intellectual disability (n = 5) such as cerebral palsy. At the time of diagnosis, 12 patients had severe malnutrition and 8 patients had obesity (4 with severe obesity). 35 patients had deficiency confirmed by low plasma ascorbic acid. Presenting symptoms included musculoskeletal - including joint pain or gait disturbance (n = 16), gingival bleeding or hypertrophy (n = 8), bruising (n = 7), or petechiae (n = 3). Other past medical history included gastrointestinal disorders (inflammatory bowel disease, celiac disease, short bowel syndrome, and eosinophil-associated diseases); hematologic conditions (beta-thalassemia, hemoglobin H, leukemia), and multiple food allergies. One patient was post-bariatric surgery. The most common co-occurring deficiencies were iron, vitamin D, and vitamin A.

Conclusions: Highly restrictive dietary intake places patients across the BMI spectrum at increased risk for micronutrient deficiencies, including scurvy. In this 20-year retrospective study, musculoskeletal complaints were the most common presenting symptoms, and many patients lacked traditional scurvy symptoms such as bleeding gums, bruising or petechiae. Although pediatric scurvy is uncommon, it is not absent from modern medicine and may be underrecognized.

Funding Sources: NIH NIDDK