1
|
Trinh K, Patel R, Peters SM. A 3-Year-Old With Gingival Hemorrhage and Musculoskeletal Pain. JAMA 2024; 331:1856-1857. [PMID: 38717779 DOI: 10.1001/jama.2024.3580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
A 3-year-old had spontaneous gingival hemorrhage and bilateral limb weakness with inability to bear weight. He had no preceding oral trauma or recent infection, took no regular medications, and had no recent use of aspirin or nonsteroidal anti-inflammatory drugs; his diet was limited to primarily chicken nuggets and milk. What is the diagnosis and what would you do next?
Collapse
Affiliation(s)
- Khanh Trinh
- Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, New York
| | | | - Scott M Peters
- Division of Oral and Maxillofacial Pathology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania
| |
Collapse
|
2
|
DeSena G, Yi L, Singh A, Sande M, Bryer B. A 12-year-old boy with petechiae, arthralgias, and muscle weakness. Pediatr Dermatol 2024; 41:531-533. [PMID: 38291991 DOI: 10.1111/pde.15535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Grace DeSena
- University of Florida College of Medicine, Florida, USA
| | - Lauren Yi
- Department of Dermatology, University of Virginia, Virginia, USA
| | - Amrit Singh
- Department of Pathology, University of Virginia, Virginia, USA
| | - Margaret Sande
- Department of Emergency Medicine, University of Virginia, Virginia, USA
| | - Bridget Bryer
- Department of Dermatology, University of Virginia, Virginia, USA
| |
Collapse
|
3
|
de Boer HC, Sawhney JS. Pediatric scurvy case report: a novel presentation with deep vein thrombosis secondary to large bilateral spontaneous iliac subperiosteal hematomas. BMC Pediatr 2024; 24:126. [PMID: 38365603 PMCID: PMC10870519 DOI: 10.1186/s12887-024-04579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/20/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Scurvy is an uncommon disease in developed countries caused by deficiency of vitamin C. We present a case of scurvy in a 14-year-old male with autism with both novel presentation and imaging findings. This case had the novel presentation of lower limb deep vein thrombosis (DVT) secondary to compression of the external iliac vein from large bilateral iliac wing subperiosteal hematomas. Subperiosteal hematoma is a well-recognised feature of scurvy but large and bilateral pelvic subperiosteal hematoma causing DVT has not previously been described. CASE PRESENTATION A 14 year old Caucasian male with background of autism and severe dietary restriction presented with lower limb swelling and immobility. He was diagnosed with lower limb DVT. Further investigation revealed an iron deficiency anaemia, and he was found on MRI to have large bilateral subperiosteal iliac hematomata causing compression of the iliac vessels. He improved following treatment with vitamin C replacement and follow-up imaging demonstrated resolution of the DVT and hematoma. CONCLUSION DVT is rare in children and when diagnosed should prompt investigation as to the underlying cause. This case demonstrates an unusual cause of DVT and as an unusual presentation of paediatric scurvy.
Collapse
|
4
|
Appiah MM, Bohrer N, Galati A, Vuong C, Tucker SM, Hightower G. Vitamin C deficiency presenting as pseudoscleroderma in a pediatric patient with food aversion. JAAD Case Rep 2024; 44:82-84. [PMID: 38304101 PMCID: PMC10831238 DOI: 10.1016/j.jdcr.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Margaret M. Appiah
- Department of Dermatology, University of Washington Medicine, Seattle, Washington
| | - Nicholas Bohrer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Aidan Galati
- School of Medicine, University of California San Diego, San Diego, California
| | - Carrie Vuong
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Suzanne M. Tucker
- Department of Pathology, Rady Children's Hospital, San Diego, California
| | - George Hightower
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
- Department of Dermatology, University of California San Diego, San Diego, California
| |
Collapse
|
5
|
Gilley SP, Ta A, Pryor W, Roper B, Erickson M, Fenton LZ, Tchou MJ, Cotter JM, Moore JM. What Do We C in Children With Scurvy? A Case Series Focused on Musculoskeletal Symptoms. Hosp Pediatr 2024; 14:e98-e103. [PMID: 38234212 DOI: 10.1542/hpeds.2023-007336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Vitamin C deficiency in children commonly presents with musculoskeletal symptoms such as gait disturbance, refusal to bear weight, and bone or joint pain. We aimed to identify features that could facilitate early diagnosis of scurvy and estimate the cost of care for patients with musculoskeletal symptoms related to scurvy. METHODS We conducted a retrospective chart review of patients at a single site with diagnostic codes for vitamin C deficiency, ascorbic acid deficiency, or scurvy. Medical records were reviewed to identify characteristics including presenting symptoms, medical history, and diagnostic workup. The Pediatric Health Information System was used to estimate diagnostic and hospitalization costs for each patient. RESULTS We identified 47 patients with a diagnosis of scurvy, 49% of whom had a neurodevelopmental disorder. Sixteen of the 47 had musculoskeletal symptoms and were the focus of the cost analysis. Three of the 16 had moderate or severe malnutrition, and 3 had overweight or obesity. Six patients presented to an emergency department for care, 11 were managed inpatient, and 3 required critical care. Diagnostic workups included MRI, computed tomography, echocardiogram, endoscopy, lumbar puncture, and/or EEG. Across all patients evaluated, the cost of emergency department utilization, imaging studies, diagnostic procedures, and hospitalization totaled $470 144 (median $14 137 per patient). CONCLUSIONS Children across the BMI spectrum, particularly those with neurodevelopmental disorders, can develop vitamin C deficiency. Increased awareness of scurvy and its signs and symptoms, particularly musculoskeletal manifestations, may reduce severe disease, limit adverse effects related to unnecessary tests/treatments, and facilitate high-value care.
Collapse
Affiliation(s)
| | - Allison Ta
- Department of Pediatrics, Sections of Nutrition
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Cincinnati School of Medicine, Cincinnati, Ohio
- Digestive Health Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William Pryor
- Departments of Radiology
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Brennan Roper
- Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Department of Orthopedics, University of Texas, Houston, Houston, Texas
| | - Mark Erickson
- Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | | |
Collapse
|
6
|
Falkenberg AL, Karkenny AJ, Sharkey MS. Orthopaedic Manifestations of Scurvy in an Otherwise Healthy Child from a Low Opportunity Index Neighborhood: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00037. [PMID: 38422190 DOI: 10.2106/jbjs.cc.23.00671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
CASE A 23-month-old otherwise healthy female child from a low opportunity index neighborhood presented with 1 month of lower extremity pain and refusal to bear weight. Radiographic evaluation of bilateral knees revealed lucent metaphyseal bands and a nondisplaced distal femoral metaphyseal corner fracture. A workup identified vitamin C deficiency (scurvy), and the child's symptoms and radiographic abnormalities resolved with vitamin C supplementation. CONCLUSIONS Scurvy should be considered in children with unexplained musculoskeletal symptoms who may lack access to nutrient-dense foods.
Collapse
Affiliation(s)
| | - Alexa J Karkenny
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, New York
| | - Melinda S Sharkey
- Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, New York
| |
Collapse
|
7
|
Yu HNZ, Chia SY. Scurvy presenting as difficulty in walking in a child. BMJ Case Rep 2023; 16:e258819. [PMID: 38160038 PMCID: PMC10759024 DOI: 10.1136/bcr-2023-258819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Scurvy, a disease caused by ascorbic acid (vitamin C) deficiency, is a rare disease in the modern world. We report a case of a boy in middle childhood, with a background of autism, presenting bed-bound due to progressive bilateral lower limb pain, with concomitant rashes, bleeding gums and worsening lethargy. Detailed dietary history revealed a severely restricted diet. Physical examination showed bilateral lower limb ecchymoses, perifollicular hemorrhages, perifollicular hyperkeratosis and cockscrew hairs which are pathognomonic features of scurvy. A low serum ascorbic acid level confirmed the diagnosis. Therapy with oral vitamin C supplement and rehabilitation with multidisciplinary care was successful, with complete resolution of symptoms. This case emphasises the importance of thorough dietary evaluation in children with autism and food selectivity presenting with non-specific symptoms. Physician awareness of nutritional deficiencies avoids unnecessary extensive investigations and sub-specialty referrals and translates to savings in medical expenses.
Collapse
Affiliation(s)
| | - Shi Yun Chia
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
8
|
Miraj F, Karda IWAM, Abdullah A, Dionysios E. Lessons learned from "the great mimicker disease": A retrospective study of 18 patients with scurvy. J Child Orthop 2023; 17:618-625. [PMID: 38050589 PMCID: PMC10693847 DOI: 10.1177/18632521231213150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Purpose Scurvy is an uncommon medical condition that affects children and is caused by an inadequate intake of vitamin C. This study presents the characteristics of patients with scurvy to raise awareness of the diagnostic process in developing countries where laboratory testing for vitamin C levels is often not available. Methods A retrospective study was performed from period of 2018 to 2023. Data extraction includes patient age, sex, body mass index, constitutional symptoms, musculoskeletal, mucosal, cutaneous symptoms, other accompanying disorders, anemia, erythrocyte sedimentation rate, C-reactive protein, radiographic examination, vitamin C dose, and duration of treatment. Descriptive statistical analysis was performed in this study. Results Eighteen cases (17 males, 1 female) of scurvy were referred to our institution. Thirteen of 18 patients were misdiagnosed before referral. The median age at presentation was 4.5 (range, 2-11) years. The average body mass index was 13.93 ± 0.63 kg/m2. Half of patients had healthy weight. All patients presented with lower limb pain and 17 of 18 with refusal to walk. The median onset of diagnosis was 11 (range 4-48) weeks. White line of Frankel was described in all patients. Seven had anemia and 6 of 18 had increase in erythrocyte sedimentation rate and/or C-reactive protein levels. Only one patient had ascorbic acid levels evaluation before treatment since it was not readily available in our country. Treatment length varied from 2 weeks to 6 months. Conclusion The diagnosis of scurvy is frequently delayed due to its extreme rarity in modern society and its ability to mimic numerous other conditions. In children presenting with limb pain and/or reluctance to walk and pathognomonic radiological findings, physicians must prioritize scurvy as a differential diagnosis. In scurvy, vitamin C supplementation is curative.
Collapse
Affiliation(s)
- Faisal Miraj
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - I Wayan Arya Mahendra Karda
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ali Abdullah
- Division of Orthopaedic and Traumatology, Department of Surgery, Persahabatan General Hospital, Jakarta, Indonesia
| | - Eugene Dionysios
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
9
|
Kinlin LM, Weinstein M. Scurvy: old disease, new lessons. Paediatr Int Child Health 2023; 43:83-94. [PMID: 37795755 DOI: 10.1080/20469047.2023.2262787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Scurvy, the condition associated with severe vitamin C deficiency, is believed to be one of the oldest diseases in human history. It was particularly prevalent during the Age of Sail, when long sea voyages without access to fresh food resulted in an epidemic which claimed millions of lives; however, scurvy has existed across time and geography, occurring whenever and wherever diets are devoid of vitamin C. Young children, specifically, were affected by the emergence of 'infantile scurvy' in the 19th century owing to the use of heated milk and manufactured infant foods of poor nutritional quality. Scurvy continues to occur in at-risk groups. In children and youths, it is primarily observed in the context of autism spectrum disorder and feeding problems such as a limited food repertoire and high-frequency single food intake. Diagnosis may be delayed and invasive testing undertaken owing to clinicians' lack of familiarity with the disease, or the mistaken assumption that it is exclusively a disease of the past. The aetiology, clinical manifestations and treatment of scurvy are described. Its long history and current epidemiology are also reviewed, demonstrating that scurvy is very much a disease of the present. It is suggested that future efforts should focus on (i) anticipatory guidance and early nutritional intervention, informed by an understanding of scurvy's epidemiology, with the aim of preventing the disease in those at risk, and (ii) prompt recognition and treatment to minimise morbidity and healthcare costs.Abbreviations: ASD: autism spectrum disorder.
Collapse
Affiliation(s)
- Laura M Kinlin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Weinstein
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Gandhi M, Elfeky O, Ertugrul H, Chela HK, Daglilar E. Scurvy: Rediscovering a Forgotten Disease. Diseases 2023; 11:78. [PMID: 37366866 DOI: 10.3390/diseases11020078] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Scurvy is a nutritional deficiency caused by low vitamin C levels that has been described since ancient times. It leads to a varied presentation, affecting multiple organ systems due to its role in the biochemical reactions of connective tissue synthesis. Common manifestations include gingival bleeding, arthralgias, skin discoloration, impaired wound healing, perifollicular hemorrhage, and ecchymoses. Although there has been a dramatic reduction in the prevalence of scurvy in modern times owing to vitamin C supplementation and intake, sporadic cases still occur. In developed countries, it is mainly diagnosed in the elderly and malnourished individuals and is associated with alcoholism, low socio-economic status, and poor dietary habits. Scurvy has been an unusual cause of gastrointestinal (GI) bleeding among other GI manifestations. It can be adequately treated and prevented via vitamin C supplementation.
Collapse
Affiliation(s)
- Mustafa Gandhi
- Department of Internal Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Omar Elfeky
- Department of Medicine, University of Florida, Leesburg, FL 32611, USA
| | - Hamza Ertugrul
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| | - Harleen Kaur Chela
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| | - Ebubekir Daglilar
- Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA
| |
Collapse
|
11
|
Elouali A, El Haddar Z, Bouabdella Y, Rkain M, Babakhouya A. A Case of Scurvy in a Child: An Uncommon but Important Diagnosis to Consider. Cureus 2023; 15:e39369. [PMID: 37362528 PMCID: PMC10285571 DOI: 10.7759/cureus.39369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Scurvy is a rare disease resulting from a prolonged ascorbic acid deficiency. It commonly affects individuals with low incomes and limited access to fresh fruits and vegetables. The diagnosis of scurvy can be challenging for clinicians due to the non-specific symptoms, resulting in extensive investigations and a delayed diagnosis. We report the case of a 14-year-old girl who presented with symptoms of pallor, bone pain, inability to walk, petechiae, ecchymosis of the lower limbs, irritability, and swollen, bleeding gums. Initially, the symptoms raised suspicions of hematopoietic malignancies, such as leukemia, and the patient underwent a series of invasive diagnostic exams before arriving at the correct diagnosis. Following a detailed dietary anamnesis with the parents, it became evident that the patient had a limited intake of fresh fruits and vegetables. A vitamin C blood test confirmed the diagnosis of scurvy. The prompt resolution of the clinical symptoms after the administration of vitamin C provided further confirmation of the diagnosis. This case highlights the importance of considering a patient's medical history and symptoms rigorously to avoid unnecessary, expensive, and invasive medical procedures, as well as to prevent potential misdiagnosis.
Collapse
Affiliation(s)
- Aziza Elouali
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Zohair El Haddar
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Yasser Bouabdella
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Maria Rkain
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Abdeladim Babakhouya
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| |
Collapse
|
12
|
Kim GC, Davidson AM, Beyda RM, Eissa MA. Scurvy, abnormal MRI, and gelatinous bone marrow in an adolescent with avoidant restrictive food intake disorder. J Eat Disord 2023; 11:41. [PMID: 36941672 PMCID: PMC10029247 DOI: 10.1186/s40337-023-00770-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Although medical literature describes pediatric scurvy as "rare", a growing number of case reports suggests otherwise. Patients often undergo costly and unnecessary workup due to unfamiliarity with the presentation of scurvy. This case report further supports the small yet growing literature documenting scurvy and its manifestations in patients with eating disorders. CASE PRESENTATION A 15-year-old female presented to the emergency department with bilateral knee and ankle swelling and pain in the setting of chronic lower limb rash and BMI of 16.3. For years, she had restricted her diet to carbohydrates. Exam showed perifollicular petechial hemorrhagic rash with corkscrew hairs, knee edema, ankle edema with restricted range of motion, and antalgic gait. She was admitted for severe malnutrition from avoidant restrictive food intake disorder. Her hospital course was complicated by recurrent normocytic anemia and fever. Hematology workup revealed anemia from iron deficiency, vitamin K deficiency, and anemia of chronic disease. Rheumatology workup was negative. MRI findings showed dark T1 and bright T2 signals and were read as consistent with leukemia/lymphoma, chronic multifocal osteomyelitis, or Langerhans cell histiocytosis. However, bone marrow biopsy showed gelatinous transformation secondary to malnutrition. She was treated with vitamin C and a nutrition plan and her symptoms improved. CONCLUSIONS Although this patient had common manifestations of scurvy, including perifollicular petechial hemorrhagic rash, joint effusions, anemia, and recurrent fevers, she still underwent an extensive workup. Clinicians should be aware that scurvy can present with multiple symptoms that mimic infectious, rheumatic, oncologic and hematological disease. Clinicians should have a high index of suspicion for scurvy in patients with malnutrition and eating disorders.
Collapse
Affiliation(s)
- Ginny Claire Kim
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA.
| | - Asha M Davidson
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA
| | - Rebecca M Beyda
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA
| | - Mona A Eissa
- University of Texas Health Science Center, 6431 Fannin, MSB 3.150, Houston, TX, 77030, USA
| |
Collapse
|
13
|
Ding TG, Goh F, Hayman R. Easily missed, easily treatable: A case of non-weight bearing, an MRI and scurvy. J Paediatr Child Health 2023; 59:395-397. [PMID: 36464998 DOI: 10.1111/jpc.16299] [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: 08/09/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/07/2022]
Affiliation(s)
- Thomas G Ding
- Department of Paediatric, Kidz First Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Fern Goh
- Radiology Department, Middlemore Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Rebecca Hayman
- Department of Paediatric, Kidz First Hospital, Te Whatu Ora, Auckland, New Zealand
| |
Collapse
|
14
|
Jin B, Liu S, Jin D. Electrochemical sensor based on carbon material derived from
Physalis alkekengi
L. husks for the analysis of ascorbic acid. ASIA-PAC J CHEM ENG 2022. [DOI: 10.1002/apj.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Biao Jin
- Analysis and Testing Center Yanbian University Yanji China
| | - Shanshan Liu
- Department of Chemistry, College of Science Yanbian University Yanji China
| | - Dongri Jin
- Department of Chemistry, College of Science Yanbian University Yanji China
| |
Collapse
|
15
|
Thaler R, Khani F, Sturmlechner I, Dehghani SS, Denbeigh JM, Zhou X, Pichurin O, Dudakovic A, Jerez SS, Zhong J, Lee JH, Natarajan R, Kalajzic I, Jiang YH, Deyle DR, Paschalis EP, Misof BM, Ordog T, van Wijnen AJ. Vitamin C epigenetically controls osteogenesis and bone mineralization. Nat Commun 2022; 13:5883. [PMID: 36202795 PMCID: PMC9537512 DOI: 10.1038/s41467-022-32915-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Vitamin C deficiency disrupts the integrity of connective tissues including bone. For decades this function has been primarily attributed to Vitamin C as a cofactor for collagen maturation. Here, we demonstrate that Vitamin C epigenetically orchestrates osteogenic differentiation and function by modulating chromatin accessibility and priming transcriptional activity. Vitamin C regulates histone demethylation (H3K9me3 and H3K27me3) and promotes TET-mediated 5hmC DNA hydroxymethylation at promoters, enhancers and super-enhancers near bone-specific genes. This epigenetic circuit licenses osteoblastogenesis by permitting the expression of all major pro-osteogenic genes. Osteogenic cell differentiation is strictly and continuously dependent on Vitamin C, whereas Vitamin C is dispensable for adipogenesis. Importantly, deletion of 5hmC-writers, Tet1 and Tet2, in Vitamin C-sufficient murine bone causes severe skeletal defects which mimic bone phenotypes of Vitamin C-insufficient Gulo knockout mice, a model of Vitamin C deficiency and scurvy. Thus, Vitamin C's epigenetic functions are central to osteoblastogenesis and bone formation and may be leveraged to prevent common bone-degenerating conditions.
Collapse
Affiliation(s)
- Roman Thaler
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
- Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, USA.
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Farzaneh Khani
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ines Sturmlechner
- Departments of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Janet M Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Xianhu Zhou
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Oksana Pichurin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Sofia S Jerez
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Jian Zhong
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jeong-Heon Lee
- Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, USA
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ramesh Natarajan
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ivo Kalajzic
- Department of Reconstructive Sciences, UConn Health, Farmington, CT, USA
| | - Yong-Hui Jiang
- Department of Genetics, Neuroscience, and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - David R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - Barbara M Misof
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - Tamas Ordog
- Epigenomics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering and Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
16
|
Gehle SC, Zwemer EK, Harrison WN. Limping Toward Improvement: The Value of Communicating Diagnostic Uncertainty. Hosp Pediatr 2022; 12:e288-e290. [PMID: 35851918 DOI: 10.1542/hpeds.2022-006625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stephanie C Gehle
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Eric K Zwemer
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Wade N Harrison
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
17
|
Trapani S, Rubino C, Indolfi G, Lionetti P. A Narrative Review on Pediatric Scurvy: The Last Twenty Years. Nutrients 2022; 14:nu14030684. [PMID: 35277043 PMCID: PMC8840722 DOI: 10.3390/nu14030684] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. We performed an extensive review of the literature analyzing studies published in the last 20 years focusing on clinical features, differential diagnosis and diagnostic delay. Fifteen articles were selected, collectively reporting a total of 166 children. Because of the wide clinical spectrum (musculoskeletal complaints and/or mucocutaneous lesions or systemic symptoms), scurvy can mimic several conditions, including autoimmune diseases, infections, and neoplasia. In addition, frequent findings such as normal nutritional status, anemia or elevated inflammatory markers may guide clinicians towards the abovementioned misdiagnoses. Scurvy should be considered in patients presenting with musculoskeletal complaints, not only in those with risk factors but also in healthy children. A focused dietary history and a careful physical examination, assessing other signs of vitamin C deficiency, are mandatory in these patients. When suspected, the dosage of serum vitamin C is the diagnostic gold standard; furthermore, imaging studies, performed by an expert radiologist, can reveal the typical features of scurvy. Only early diagnosis can avoid unnecessary investigations and potentially fatal complications of the disease.
Collapse
Affiliation(s)
- Sandra Trapani
- Pediatric Unit, Department of Health Sciences, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy
- Correspondence: ; Tel.: +39-055-5662480
| | - Chiara Rubino
- Pediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50137 Florence, Italy;
| | - Giuseppe Indolfi
- Pediatric Unit, Department of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy;
| | - Paolo Lionetti
- Gastroenterology Unit, Department of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy;
| |
Collapse
|
18
|
Thiemann S, Cimorelli V, Bajwa NM. Case Report: Uncommon cause of limp in the 21 st century. Front Endocrinol (Lausanne) 2022; 13:968015. [PMID: 35979442 PMCID: PMC9377508 DOI: 10.3389/fendo.2022.968015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
Scurvy results from a deficiency of ascorbic acid. This disease first appeared in children during the 19th century with the emergence of new dietary habits; in particular, heating milk that leads to a loss of ascorbic acid. Even though scurvy has become a rare condition in western countries, many cases are still reported in pediatric patients, especially in those who lack proper nutrition due to neurological or psychiatric illnesses. Symptoms include bleeding and swollen gums, loosening of teeth, bone abnormalities, arthralgia, delayed wound healing, anemia, petechiae, and purpura. Bone lesions are mainly irregularities of long bones metaphyses. We report the case of a five-year-old boy who presented with arthralgia and limb deformation (genu valgum). The patient was investigated for vitamin deficiencies to exclude rickets. The radiologic investigations revealed metaphyseal signs compatible with scurvy. During the hospitalization, the patient was observed to have abnormal eating patterns and the scurvy was attributed to malnutrition. Although the occurrence of scurvy is rare, it remains essential to detect this disease in children at risk of developing vitamin deficiencies. Without targeted treatment, the complications of scurvy can be serious and potentially fatal.
Collapse
Affiliation(s)
- Stephanie Thiemann
- Department of Women, Children, and Adolescents, Service of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Valeria Cimorelli
- Department of Women, Children, and Adolescents, Service of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia M. Bajwa
- Department of Women, Children, and Adolescents, Service of General Pediatrics, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education, University of Geneva Faculty of Medicine, Geneva, Switzerland
- *Correspondence: Nadia M. Bajwa,
| |
Collapse
|
19
|
Cano Calderero FX, Santelli Romano MD. Scurvy, a disease forgotten as cause of gastrointestinal manifestations. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:437-438. [PMID: 34544676 DOI: 10.1016/j.rgmxen.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- F X Cano Calderero
- Servicio de Digestivo, Hospital Universitario San Agustín de Avilés, Principado de Asturias, Spain.
| | - M D Santelli Romano
- Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| |
Collapse
|
20
|
Cano Calderero FX, Santelli Romano MD. Scurvy, a disease forgotten as cause of gastrointestinal manifestations. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:S0375-0906(21)00084-7. [PMID: 34481680 DOI: 10.1016/j.rgmx.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/01/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- F X Cano Calderero
- Servicio de Digestivo, Hospital Universitario San Agustín de Avilés. Principado de Asturias, Asturias, España.
| | - M D Santelli Romano
- Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil. Ecuador, Guayaquil, Ecuador
| |
Collapse
|
21
|
Tetrahexyldecyl Ascorbate (THDC) Degrades Rapidly under Oxidative Stress but Can Be Stabilized by Acetyl Zingerone to Enhance Collagen Production and Antioxidant Effects. Int J Mol Sci 2021; 22:ijms22168756. [PMID: 34445461 PMCID: PMC8395926 DOI: 10.3390/ijms22168756] [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: 07/13/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
Tetrahexyldecyl Ascorbate (THDC) is an L-ascorbic acid precursor with improved stability and ability to penetrate the epidermis. The stability and transdermal penetration of THDC, however, may be compromised by the oxidant-rich environment of human skin. In this study, we show that THDC is a poor antioxidant that degrades rapidly when exposed to singlet oxygen. This degradation, however, was prevented by combination with acetyl zingerone (AZ) as a stabilizing antioxidant. As a standalone ingredient, THDC led to unexpected activation of type I interferon signaling, but this pro-inflammatory effect was blunted in the presence of AZ. Moreover, the combination of THDC and AZ increased expression of genes associated with phospholipid homeostasis and keratinocyte differentiation, along with repression of MMP1 and MMP7 expression, inhibition of MMP enzyme activity, and increased production of collagen proteins by dermal fibroblasts. Lastly, whereas THDC alone reduced viability of keratinocytes exposed to oxidative stress, this effect was completely abrogated by the addition of AZ to THDC. These results show that AZ is an effective antioxidant stabilizer of THDC and that combination of these products may improve ascorbic acid delivery. This provides a step towards reaching the full potential of ascorbate as an active ingredient in topical preparations.
Collapse
|
22
|
Liuzzo Scorpo M, Corsello G, Maggio MC. Scurvy as an Alarm Bell of Autistic Spectrum Disorder in the First World: A Case Report of a 3-Year-Old Girl. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930583. [PMID: 34339404 PMCID: PMC8349570 DOI: 10.12659/ajcr.930583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Scurvy secondary to deficiency of vitamin C is a rare condition in children. The polymorphism of clinical signs and symptoms makes scurvy diagnosis a challenge for the pediatrician. CASE REPORT A 3-year-old girl came to our observation because she refused to walk and to stand, she showed petechiae, follicular hyperkeratosis on the limbs, and bleeding gums. After a physical exam, laboratory tests, and X-ray examinations, we suspected scurvy disease and started treatment with vitamin C. During the hospitalization, some relationship difficulties of the little girl emerged such as absence of eye contact, smiling and laughter without reason, solitary play activities, poor interaction with strangers, non-communicative language, and gestural stereotypes. Therefore, we suspected an autism spectrum disorder, which is often associated with vitamins intake deficiency secondary to food selectivity. After the administration of vitamins, there was a clinical improvement. Due to the suspicion of autism spectrum disorder, the neuropsychiatric team started neuro-psychomotor and speech therapy. CONCLUSIONS This case shows that although the incidence of scurvy has been greatly reduced in Western Europe, this pathology can still manifest itself, especially in vulnerable children, and its prompt diagnosis and therapy are important considering the excellent response to treatment.
Collapse
Affiliation(s)
| | - Giovanni Corsello
- Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | |
Collapse
|