Unusual Presentation of Pediatric Scurvy: A Necrotic Gastrostomy Tube Site in a 14-Year-Old Boy

Nicholas R. Zessis*, Sarah W. Peters, Jonathan D. Samet, Simon Parzen-Johnson, Laura T. Russo, Waheeda Samady, Rebecca Stephen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Case Report: Conclusions: Despite being considered a disease of the past, pediatric scurvy is increasingly reported in developed countries, especially among children with autism spectrum disorder, developmental delays, or a restrictive diet. Pediatric patients typically present with lower extremity pain or refusal to walk. This case study features an atypical presentation of scurvy in a non-ambulatory patient. A 14-year-old boy with arthrogryposis multiplex congenita displayed a late-stage scurvy symptom: a necrotic gastrostomy tube site, indicative of poor wound healing due to vitamin C deficiency. The usual telltale symptoms of scurvy were camouflaged due to his non-ambulatory status, which may have contributed to a delayed presentation. Nevertheless, a comprehensive clinical evaluation, incorporating diet history, gingival symptoms, petechiae, and characteristic radiological signs, eventually led to the correct diagnosis. Although acute osteomyelitis was initially suspected, it was subsequently ruled out. Upon initiation of vitamin C therapy, the patient’s symptoms subsided within a few days, and the necrotic tissue surrounding the gastrostomy tube healed completely within two weeks. The highlighted case underscores the importance of including scurvy in the differential diagnosis for pediatric patients with lower extremity pain without fever. A detailed dietary history focusing on vitamin C intake is crucial during clinical evaluation. Early initiation of vitamin C therapy, when scurvy is suspected, may prevent unnecessary and extensive diagnostic workup for other potential causes, offering timely relief to the patient.

Original languageEnglish (US)
Article numbere940770
JournalAmerican Journal of Case Reports
Volume24
DOIs
StatePublished - 2023

Keywords

  • Arthrogryposis Multiplex Congenita Neurogenic Type
  • Osteomyelitis
  • Scurvy

ASJC Scopus subject areas

  • General Medicine

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