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Susilo F, Clarissa S, Handoyono QF, Simargi Y, Ronny, Nurprasetyo. A case report of a childhood scurvy musculoskeletal manifestation: Radiologic findings and diagnostic implications. Radiol Case Rep 2024; 19:3235-3239. [PMID: 38800077 PMCID: PMC11126872 DOI: 10.1016/j.radcr.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
Scurvy is an infrequent pathological condition resulting from a sustained dietary vitamin C deficiency. Radiology becomes pivotal because the diagnostic process for scurvy can be intricate, given its resemblance to bone neoplasms. A 6-year-old boy, reported persistent pain and swelling in the right thigh for 2 months prior to hospitalization. Clinical examination revealed a mass localized in the right thigh and anemia. A radiograph of the right femur demonstrated extensive osteopenic changes, "Trümmerfeld zone", "Frankel line", "Pelkin fracture", "Wimberger ring sign", and para-epiphyseal subperiosteal hematoma. The absence of any such cases in our institution over the preceding decade emphasizes the uniqueness of this presentation. Histopathological evaluation yielded atypical results, prompting further radiographic assessment of the left femur and thorax. The subsequent findings corroborated the classic "scorbutic rosary" presentation, indicative of scurvy. The patient's symptoms gradually resolved with high-dose supplementation of vitamin C. Scurvy predominantly presents with musculoskeletal manifestations. Plasma vitamin C level assessment is the gold standard for the diagnosis, but it is currently inaccessible in our nation. Consequently, radiographic evaluation reveals pathognomonic features of the disorder. In thoracic radiographs, the "scorbutic rosary" presentation is evident. In contrast, long bones exhibit hallmarks of scurvy: diffuse osteopenia, "Frankel line", "Trümmerfeld zone", "Pelkin fracture", "Wimberger ring sign", and para-epiphyseal subperiosteal hematoma. Prompt intervention with vitamin C thwarts the progression to severe complications. Radiology is an indispensable tool in diagnosing pediatric scurvy, especially in developmental countries where the assessment of vitamin C serum levels is inaccessible.
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Affiliation(s)
- Fenny Susilo
- Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
| | - Stella Clarissa
- Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
- Department of Radiology, Doctor Soedarso General Hospital, Pontianak, Indonesia
| | - Quinta F. Handoyono
- Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
| | - Yopi Simargi
- Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
| | - Ronny
- Department of Radiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
| | - Nurprasetyo
- Department of Radiology, Doctor Soedarso General Hospital, Pontianak, Indonesia
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Lu RL, Guo JW, Sun BD, Chen YL, Liu DZ. Scurvy in a young man: a rare case report. Front Nutr 2023; 10:1265334. [PMID: 37915623 PMCID: PMC10616463 DOI: 10.3389/fnut.2023.1265334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Scurvy, resulting from vitamin C deficiency, has nonspecific constitutional symptoms, including weakness, malaise, and fatigue. It is frequently misdiagnosed due to the lack of specific clinical manifestations. Although there are sporadic cases of scurvy currently reported in children, scurvy in young people is seldom encountered. Here, we report on a 25-year-old male patient without any underlying conditions who presented with severe pain and ecchymoses of both lower extremities. He was diagnosed with scurvy due to a long history of staying indoors and inadequate intake of fruits or vegetables.
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Affiliation(s)
- Rui-Ling Lu
- The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen, China
| | - Jie-Wen Guo
- The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen, China
| | - Bao-dong Sun
- The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen, China
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, Shenzhen, China
| | - Yu-Lan Chen
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, Shenzhen, China
| | - Dong-Zhou Liu
- Department of Rheumatology and Immunology, Shenzhen People’s Hospital, Shenzhen, China
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Matijasic N, Kranjcec I, Jadrijevic-Cvrlje F, Tripalo Batos A, Sekelj Fures J, Stepan Giljevic J. Deep Tissue Hematomas-What Are We Forgetting? Clin Pediatr (Phila) 2023; 62:59-63. [PMID: 35848545 DOI: 10.1177/00099228221110116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nusa Matijasic
- Department of Paediatric Oncology and Haematology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Izabela Kranjcec
- Department of Paediatric Oncology and Haematology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Filip Jadrijevic-Cvrlje
- Department of Paediatric Oncology and Haematology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ana Tripalo Batos
- Department of Paediatric Radiology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Jadranka Sekelj Fures
- Department of Paediatric Neurology, Children's Hospital Zagreb, Zagreb, Croatia.,Faculty of Medicine, The Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jasminka Stepan Giljevic
- Department of Paediatric Oncology and Haematology, Children's Hospital Zagreb, Zagreb, Croatia.,Medical School, University of Zagreb, Zagreb, Croatia
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Wong NX, Bartlett M, Roberts K. The limping child's curvy diagnosis. J Paediatr Child Health 2022; 58:1085-1087. [PMID: 34590389 DOI: 10.1111/jpc.15762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Nicole X Wong
- Paediatrics and Child Health, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Murray Bartlett
- I-TeleRad, IMED Radiology Network, Sydney, New South Wales, Australia
| | - Kathryn Roberts
- Paediatrics and Child Health, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Impact of Moriamin Forte on Testicular and Epididymal Damage in Rats with Oligoasthenospermia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4059248. [PMID: 34211561 PMCID: PMC8208844 DOI: 10.1155/2021/4059248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 05/11/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
To investigate the effect and mechanism of action of Moriamin Forte (MF) on oligoasthenospermia (OA) in rats exposed to multiglycosides of Tripterygium wilfordii (GTW), forty male Sprague Dawley rats were randomly divided into four groups. Rats in the control group were treated with 0.5% sodium carboxymethyl cellulose. The remaining rats were administered GTW (30 mg/kg/d) for 40 d to establish an OA model. Concurrently, the groups were treated with normal saline and low-dose (100 mg/kg/d) and high-dose (200 mg/kg/d) MF, respectively. After treatment, the number and motility of sperm cells were examined. Testicular and epididymal histomorphology changes were observed. Antioxidant indicators (SOD, CAT, MDA, TAC, and Nrf2) in testicular and epididymal tissues were detected. Apoptotic and antiapoptotic indicators (Bax and Bcl2 expression) in the testicular tissue were measured by immunohistochemistry. GTW decreased sperm count and motility, damaged testicular and epididymis tissues, impaired antioxidase activity, and increased tissue MDA levels. Meanwhile, GTW upregulated the expression of Bax and downregulated the expression of Bcl2. Western blot analysis demonstrated a decrease in the Nrf2 expression in the model group. Treatment with MF improved sperm count and motility, as well as inhibited the rate of apoptosis in the rat reproductive system. Moreover, MF improved the activity of antioxidants and increased the relative expression of the antioxidant pathway-related protein Nrf2. In conclusion, MF may reverse the GTW-induced OA by modulating the expression of apoptotic and antioxidant pathway-related proteins. This study may provide a pharmacological foundation for the use of MF in OA treatment.
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Kothari P, Tate A, Adewumi A, Kinlin LM, Ritwik P. The risk for scurvy in children with neurodevelopmental disorders. SPECIAL CARE IN DENTISTRY 2020; 40:251-259. [PMID: 32330999 DOI: 10.1111/scd.12459] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/06/2020] [Accepted: 03/20/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Scurvy, the disease resulting from vitamin C deficiency, is perceived as being rare and occurring predominantly in the past. However, scurvy continues to exist and may be encountered in children with medical/developmental conditions and/or restricted diet. Diagnosis can be challenging given the perceived rarity of the condition and nonspecific symptoms, including gingival disease. METHODS We present a series of two cases of scurvy in which the affected children presented to medical attention with dental complaints. Additional cases of scurvy are described, based on the literature review of case reports/series published in the last 10 years. RESULTS Literature review yielded 77 relevant case reports published in the English language since 2009. Most affected children had a previous diagnosis of a medical or developmental condition (especially autism spectrum disorder). Intraoral features (gingival swelling, pain, and bleeding) were noted in most of the identified cases of scurvy. Improvement in the oral features of scurvy occurred within days of vitamin C therapy initiation. CONCLUSIONS Recognizing classic signs and symptoms of scurvy enables prompt diagnosis and avoids invasive investigations. Dentists may be in a unique position to facilitate prompt and accurate diagnosis of a condition that is relatively easy and safe to treat once identified.
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Affiliation(s)
- Priya Kothari
- Kidsworld Pediatric Dentistry, Aurora, Ontario, Canada
| | - Anupama Tate
- Children's National Hospital, Washington, DC, USA.,George Washington University, Washington, DC, USA
| | - Abimbola Adewumi
- Department of Pediatric Dentistry, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Laura M Kinlin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Priyanshi Ritwik
- Department of Pediatric Dentistry, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas, USA
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