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Srienc-Ściesiek MT, Richards N, Ladstätter S, Kirchengast S. Evidence of non-adult vitamin C deficiency in three early medieval sites in the Jaun/Podjuna Valley, Carinthia, Austria. Int J Paleopathol 2024; 45:18-29. [PMID: 38520801 DOI: 10.1016/j.ijpp.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE This study aims to determine and discuss the prevalence of non-adult scurvy cases from the early medieval Jaun/Podjuna Valley in southern Austria. MATERIALS 86 non-adult individuals were assessed from three early medieval sites. METHODS Morphological characteristics associated with suggestive and probable scurvy were observed macroscopically and under 20-40x magnification. RESULTS A significant relationship between the prevalence of scurvy and age group was observed. Perinates (46%, 6/13) and children (27.5%, 8/28) showed a high prevalence of skeletal features indicating a diagnosis of scurvy, while no cases of scurvy were observed in adolescents and adults. CONCLUSIONS In this Alpine region, scurvy occurred frequently in infants and children. Seasonal fluctuations of diet are discussed as factors triggering scurvy. SIGNIFICANCE This study sheds new light on the prevalence of scurvy in the Alpine region and how the region developed after the fall of the Roman Noricum. It also models ways in which multiple lines of evidence can contribute to the diagnostic process. LIMITATIONS Poor preservation posed a challenge to identifying probable cases of scurvy. Likewise, non-adult remains are difficult to diagnose due to their developing nature and it is not always possible to distinguish between normal bone growth and pathological growth. SUGGESTIONS FOR FURTHER RESEARCH Future applications of biomolecular studies will help illustrate changes in diet that may have contributed to vitamin deficiencies.
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Affiliation(s)
- Magdalena T Srienc-Ściesiek
- Austrian Archaeological Institute, Austrian Academy of Sciences, Franz-Klein Gasse 1, Vienna 1190, Austria; Department of Evolutionary Anthropology, University of Vienna, Djerassipl. 1, Vienna 1030, Austria.
| | - Nina Richards
- Austrian Centre for Digital Humanities and Cultural Heritage, Austrian Academy of Sciences, Bäckerstraße 13, Vienna 1010, Austria
| | - Sabine Ladstätter
- Austrian Archaeological Institute, Austrian Academy of Sciences, Franz-Klein Gasse 1, Vienna 1190, Austria
| | - Sylvia Kirchengast
- Department of Evolutionary Anthropology, University of Vienna, Djerassipl. 1, Vienna 1030, Austria
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Hemilä H, de Man AME. Vitamin C deficiency can lead to pulmonary hypertension: a systematic review of case reports. BMC Pulm Med 2024; 24:140. [PMID: 38504249 PMCID: PMC10949735 DOI: 10.1186/s12890-024-02941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND In the early literature, unintentional vitamin C deficiency in humans was associated with heart failure. Experimental vitamin C deficiency in guinea pigs caused enlargement of the heart. The purpose of this study was to collect and analyze case reports on vitamin C and pulmonary hypertension. METHODS We searched Pubmed and Scopus for case studies in which vitamin C deficiency was considered to be the cause of pulmonary hypertension. We selected reports in which pulmonary hypertension was diagnosed by echocardiography or catheterization, for any age, sex, or dosage of vitamin C. We extracted quantitative data for our analysis. We used the mean pulmonary artery pressure (mPAP) as the outcome of primary interest. RESULTS We identified 32 case reports, 21 of which were published in the last 5 years. Dyspnea was reported in 69%, edema in 53% and fatigue in 28% of the patients. Vitamin C plasma levels, measured in 27 cases, were undetectable in 24 and very low in 3 cases. Diet was poor in 30 cases and 17 cases had neuropsychiatric disorders. Right ventricular enlargement was reported in 24 cases. During periods of vitamin C deficiency, the median mPAP was 48 mmHg (range 29-77 mmHg; N = 28). After the start of vitamin C administration, the median mPAP was 20 mmHg (range 12-33 mmHg; N = 18). For the latter 18 cases, mPAP was 2.4-fold (median) higher during vitamin C deficiency. Pulmonary vascular resistance (PVR) during vitamin C deficiency was reported for 9 cases, ranging from 4.1 to 41 Wood units. PVR was 9-fold (median; N = 5) higher during vitamin C deficiency than during vitamin C administration. In 8 cases, there was direct evidence that the cases were pulmonary artery hypertension (PAH). Probably the majority of the remaining cases were also PAH. CONCLUSIONS The cases analyzed in our study indicate that pulmonary hypertension can be one explanation for the reported heart failure of scurvy patients in the early literature. It would seem sensible to measure plasma vitamin C levels of patients with PH and examine the effects of vitamin C administration.
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Affiliation(s)
- Harri Hemilä
- Department of Public Health, University of Helsinki, POB 41, Helsinki, FI-00014, Finland.
| | - Angelique M E de Man
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.
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Booth SM, Kapadia TH, Tang V, Maniyar AF. Pictorial review: challenges in distinguishing bilateral metaphyseal marrow abnormalities on magnetic resonance imaging. Pediatr Radiol 2024:10.1007/s00247-024-05896-7. [PMID: 38491225 DOI: 10.1007/s00247-024-05896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Abstract
The paediatric metaphysis is afflicted by a wide range of pathological processes as it is the most metabolically active and well-vascularised part of the developing skeleton. This review focuses on metaphyseal marrow signal change detected with magnetic resonance imaging, which is most often occult on radiographs. When bilateral, these imaging appearances frequently present a diagnostic quandary. This review assists the radiologist to confidently dismiss physiological signal change and confidently work through the differential diagnosis. This is achieved by illustrating a practical method of classifying signal change into four categories: physiological red marrow, red marrow reconversion, marrow infiltration, and oedema-like marrow signal intensity. In doing so, various pathological entities are reviewed along with imaging pearls and next-step investigations.
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Affiliation(s)
- Sean M Booth
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK.
| | - Tejas H Kapadia
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
| | - Vivian Tang
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
| | - Amit F Maniyar
- Department of Radiology, Royal Manchester Children's Hospital, Oxford Road, Manchester, Lancashire, M13 9WL, UK
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Dupuy G, Roux CJ, Barrois R, Imbard A, Pontoizeau C, Dangles MT, Aubart M, Arnoux JB, Margoses D, Brassier A, Marbach C, Bérat CM, Sarda E, Gitiaux C, de Lonlay P, Boddaert N, Schiff M, Desguerre I. Vitamin deficiencies in children: Lessons from clinical and neuroimaging findings. Eur J Paediatr Neurol 2024; 50:6-15. [PMID: 38520815 DOI: 10.1016/j.ejpn.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND AND AIMS Water-soluble vitamins play an essential coenzyme role in the nervous system. Acquired vitamin deficiencies are easily treatable, however, without treatment, they can lead to irreversible complications. This study aimed to provide clinical, laboratory parameters and neuroimaging data on vitamin deficiencies in an attempt to facilitate early diagnosis and prompt supplementation. METHODS From July 1998 to July 2023, patients at Necker-Enfants-Malades Hospital presenting with acute neurological symptoms attributed to acquired vitamin deficiency were included. Clinical data were extracted from Dr Warehouse database. Neuroimaging, biochemical and electrophysiological data were reviewed. RESULTS Patients with vitamin B1 deficiency exhibited abnormal eye movements (n = 4/4), fluctuations in consciousness (n = 3/4), and ataxia (n = 3/4). Brain MRI showed alterations of fourth ventricle region (n = 4/4), periaqueductal region (n = 4/4), tectum (n = 3/4), and median thalami (n = 3/4). Patients with vitamin B2 deficiency presented with early onset hypotonia (n = 3/4), hyperlactatemia (n = 4/4), and hyperammonemia (n = 4/4). Plasma acylcarnitines revealed a multiple acyl-coA dehydrogenase deficiency-like profile (n = 4/4). In vitamin B12 deficiency, young children presented with developmental delay (n = 7/7) and older children with proprioceptive ataxia (n = 3/3). Brain MRI revealed atrophy (n = 7/7) and spinal MRI hyperintensity in posterior cervical columns (n = 3/3). Metabolic findings showed elevated methylmalonic acid (n = 6/7) and hyperhomocysteinemia (n = 6/7). Patients with vitamin C deficiency exhibited gait disturbances and muscle weakness (n = 2/2). CONCLUSIONS Acquired vitamin deficiencies may display reversible clinical symptoms mimicking inherited metabolic disorders. Some situations raise suspicion for diagnosis: concordant clinical presentation, suggestive neuroimaging findings, and/or biochemical evidence. Any acute neurological condition should be treated without waiting for definitive biochemical confirmation.
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Affiliation(s)
- Gabrielle Dupuy
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France.
| | - Charles-Joris Roux
- Pediatric Radiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Rémi Barrois
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; Pediatric Neurophysiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Apolline Imbard
- Department of Biochemistry, Necker-Enfants-Malades Hospital, APHP, University of Paris Saclay, Paris, France
| | - Clément Pontoizeau
- Department of Biochemistry, Necker-Enfants-Malades Hospital, APHP, University of Paris Saclay, Paris, France
| | - Marie Thérèse Dangles
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Mélodie Aubart
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Jean-Baptiste Arnoux
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Diane Margoses
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Anaïs Brassier
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Clothilde Marbach
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Claire-Marine Bérat
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Eugénie Sarda
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Cyril Gitiaux
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; Pediatric Neurophysiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Pascale de Lonlay
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France; INSERM U1151, Institut Necker-Enfants-Malades (INEM), Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; INSERM UMRS_1163, Imagine Institute, Paris, France
| | - Manuel Schiff
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France; INSERM UMRS_1163, Imagine Institute, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Buchanan WW, Rainsford KD, Kean CA, Kean WF. Medical aspects of the tour by Martin Martin (c 1660-1719) of the Western and Northern Islands of Scotland, Circa 1695. Inflammopharmacology 2024; 32:83-92. [PMID: 37676413 DOI: 10.1007/s10787-023-01334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
This review is based investigations on the Western Isles, Scotland, by Martin Martin, a notable Scottish Highlander, academic and medical doctor, of the 17th-18th century. His extensive observations of the geography and peoples of these Isles were recorded in his books, "On the Description of the Western Islands of Scotland Circa 1695" and "A Late Voyage to St Kilda". In these books and subsequent papers there were some noteworthy observations on the occurrence (and as he says non-occurrence) of "epidemical" diseases and conditions afflicting the peoples of The Isle of Skye and the Western Isles of Scotland in this period, and these are discussed in this review. Martin also gives details of a wide variety of remedies that were observed or reported by inhabitants around that time. Some of these remedies are interesting for their relevance to the period but others are of doubtful merit. These are reviewed here more for their significance in the understanding of the diseases and conditions of humans and even in some cases animals at that time. Introductions by Charles Withers and R.W. Munro, 11 and re-assessments of the contributions of Martin and colleagues of that time have given insight into the health and condition of peoples of the Western Isles of Scotland(the Occidental) (Martin 1695; Martin 1716).
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Affiliation(s)
- W Watson Buchanan
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | | | - Colin A Kean
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada
| | - Walter F Kean
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada.
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Satawiriya M, Khongphatthanayothin A, Limsuwan A. Reversible severe pulmonary hypertension related to scurvy in children. BMC Cardiovasc Disord 2024; 24:24. [PMID: 38172747 PMCID: PMC10765653 DOI: 10.1186/s12872-023-03629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Severe pulmonary hypertension (PH) in childhood is rare and can manifest as a life-threatening episode. We present 2 children with restrictive dietary habits with severe pulmonary hypertension secondary to scurvy and iron deficiency anemia with treatment and outcome. CASE PRESENTATION The first case is a 2-year-old boy who presented with vomiting, diarrhea, and fever. After rehydration, he had recurrent episodes of hypotension with intermittent abdominal pain. Fluid resuscitation and inotropic medication were given. Then he suddenly collapsed. After 4-min cardiopulmonary resuscitation, his hemodynamic was stabilized. Most of the medical workup was unremarkable except for PH from the echocardiogram with estimated systolic pulmonary artery pressure (PAP) at 67 mmHg. Transient PH was diagnosed, and milrinone was prescribed. Since he had restrictive dietary habits and sclerotic rim at epiphysis in chest films, his vitamin C level was tested and reported low-level result. The second case is a 6-year-old boy with acute dyspnea, a month of low-grade fever, mild cyanosis, and a swollen left knee. Echocardiogram indicated moderate TR with estimated systolic PAP at 56 mmHg (systolic blood pressure 90 mmHg). Milrinone was given. Right cardiac catheterization showed PAP 66/38 (mean 50) mmHg and PVRi 5.7 WU.m2. Other medical conditions causing PH were excluded. With a history of improper dietary intake and clinical suspicion of scurvy, vitamin C was tested and reported undetectable level. Administration of vitamin C in both cases rapidly reversed pulmonary hypertension. CONCLUSION Pediatric PH related to vitamin C deficiency can manifest with a wide range of symptoms, varying from mild and nonspecific to severe life-threatening episodes characterized by pulmonary hypertensive crises. PH associated with scurvy is entirely reversible with appropriate investigation, diagnosis, and treatment. Our report highlights the importance of considering nutritional deficiencies as potential confounding factors in pediatric PH, emphasizing the need for comprehensive evaluation and management of these patients.
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Affiliation(s)
- Marin Satawiriya
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Rachathewi, Bangkok, 10400, Thailand
| | - Apichai Khongphatthanayothin
- Bangkok Heart Hospital, Bangkok, Thailand
- Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Alisa Limsuwan
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Rachathewi, Bangkok, 10400, Thailand.
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Charlier P, Augias A, Weil R, Bouchet F, Poupon J, Popescu MS, Decloquement P, Azza S, Angelakis E, Richardin P, Colson P, Dubourg G, Million M, Raoult D. Scurvy complicated with Capnocytophaga sputigena sepsis as a possible cause of death of king Saint-Louis of France (1270 AD). Microb Pathog 2023; 185:106399. [PMID: 37884212 DOI: 10.1016/j.micpath.2023.106399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
The cause of death of Saint-Louis is not known, but recent findings indicated that he presented scurvy and inflammatory jaw disease, which has been associated with infection by oral commensals. Here, we have the exceptional opportunity to analyze the relics of the viscera of King Saint-Louis. A 4.3 g sample from the viscera relics of King Saint-Louis conserved in Versailles' cathedral was subjected to radiocarbon dating, electronic and optic microscopy, and elementary, palynological, molecular, proteomics and microbiological analyses including specific PCR and v3v4 16 S rRNA gene amplification prior to large-scale sequencing using an Illumina MiSeq instrument. The measured radiocarbon age was Cal 1290 CE-1400, which was compatible with that of the viscera of St Louis viscera, considering the addition of lime, incense and vegetables within the human organs. Elemental and palynological analyses confirmed a medieval embalming process. Proteomics analysis identified mainly human muscle and blood proteins. Specific PCR for plague, amoebiasis, shigellosis and typhoid fever was negative. C. sputigena was identified as the main pathogenic species representing 10.8 % of all microbial sequences. In contrast, C. sputigena was found in only 0.001 % of samples sequenced in our center, and the 23 positive human samples showed a dramatically lower abundance (0.02-2.6 %). In the literature, human infections with C. sputigena included odontitis, dental abscess, sinusitis, thoracic infections and bacteremia, particularly in immunocompromised patients with oral and dental diseases consistent with recent analysis of King Saint-Louis' jaw. C. sputigena, a commensal of the mouth that is potentially pathogenic and responsible for fatal bacteremia, may have been the cause of the king's death.
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Affiliation(s)
- Philippe Charlier
- Laboratory Anthropology, Archaeology, Biology (LAAB), UFR of Health Sciences (UVSQ), Paris-Saclay University, 2 Avenue de La Source de La Bièvre, 78180, Montigny-Le-Bretonneux, France; Museum of Quai Branly - Jacques Chirac, 222 Rue de L'Université, 75007, Paris, France; Fondation Anthropologie, Archéologie, Biologie (FAAB) - Institut de France, Palais de L'Institut, 23 Quai de Conti, 75006, Paris, France.
| | - Anaïs Augias
- Laboratory Anthropology, Archaeology, Biology (LAAB), UFR of Health Sciences (UVSQ), Paris-Saclay University, 2 Avenue de La Source de La Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Raphaël Weil
- Laboratory Anthropology, Archaeology, Biology (LAAB), UFR of Health Sciences (UVSQ), Paris-Saclay University, 2 Avenue de La Source de La Bièvre, 78180, Montigny-Le-Bretonneux, France; Laboratoire de Physique des Solides, CNRS, Université Paris-Sud, Université Paris-Saclay, Orsay, Cedex, 91405, France
| | - Françoise Bouchet
- Académie Nationale de Pharmacie, Avenue de L'Observatoire, 75006, Paris, France
| | - Joël Poupon
- Laboratory Anthropology, Archaeology, Biology (LAAB), UFR of Health Sciences (UVSQ), Paris-Saclay University, 2 Avenue de La Source de La Bièvre, 78180, Montigny-Le-Bretonneux, France; Laboratoire de Toxicologie Biologique, CHU Lariboisière (AP-HP), 2 Rue Ambroise Paré, 75010, Paris, France
| | | | - Philippe Decloquement
- Aix Marseille University, IRD, APHM, MEPHI, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Saïd Azza
- Aix Marseille University, IRD, APHM, MEPHI, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Emmanouil Angelakis
- Laboratory of Medical Microbiology, Hellenic Pasteur Institute, Athens, Greece
| | - Pascale Richardin
- Centre de Recherche et de Restauration des Musées de France (C2RMF), Palais Du Louvre, Porte des Lions, 14 Quai François Mitterrand, 75001, Paris, France; UMR 7055, Préhistoire et Technologie (Pretech), Université Paris Nanterre / CNRS, 21 Allée de L'Université, 92023, Nanterre Cedex, France
| | - Philippe Colson
- Aix Marseille University, IRD, APHM, MEPHI, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Gregory Dubourg
- Aix Marseille University, IRD, APHM, MEPHI, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Aix Marseille University, IRD, APHM, MEPHI, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix Marseille University, IRD, APHM, MEPHI, Marseille, France; IHU-Méditerranée Infection, Marseille, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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11
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Mashauri HL. Scurvy: A treatable forgotten fatal differential diagnosis and potential etiology of leukemia and aplastic anemia in pediatric population. Health Sci Rep 2023; 6:e1611. [PMID: 37808934 PMCID: PMC10552072 DOI: 10.1002/hsr2.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Scurvy is a rare nutritional deficiency disease which is less likely to be suspected and it mostly lead to delayed diagnosis. It can present with features which can mislead clinicians to misdiagnose the condition as leukemia or aplastic anemia. This can subject patients to the wrong management which leads to poor outcome and increased preventable morbidity and mortality. Vitamin C deficiency is still prevalent among pediatric population even in the modern days and should no longer be considered as historical condition. Chromosomal fragility has been greatly accounted for the development of leukemia and aplastic anemia secondary to various triggers. The role of vitamin C toward DNA stability, prevention, and control of mutations have been documented. Vitamin C plays a vital role in hematopoiesis by controlling regulation and prevent dysfunction of hematopoietic stem cells. Scurvy deficiency has been a silent growing clinical problem which needs a high index of suspicion for a clinician to pick it. It should be considered as one among potential differential diagnosis of leukemia and aplastic anemia especially in the pediatric population. History of any dietary restriction should be obtained and addressed properly. Serum vitamin C should be among the essential laboratory workout in diagnosis of both leukemia and aplastic anemia. All patients suspected to have such conditions should be screened and supplemented for vitamin C deficiency irrespective of positive confirmatory test results of leukemia or aplastic anemia since the probability of co-occurrence is likely also. Moreover, studies should be conducted to explore the clinical link, if any, between vitamin C deficiency or insufficiency and development of leukemia and aplastic anemia among the pediatric population given its physiological and genomic role in hematopoiesis. Furthermore, the potential pharmacological therapeutic use of vitamin C in treatment of leukemia and aplastic anemia should be determined clinically.
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Affiliation(s)
- Harold L Mashauri
- Department of Pediatrics and Child Health Kilimanjaro Christian Medical University College Moshi Tanzania
- Department of Internal Medicine Kilimanjaro Christian Medical University College Moshi Tanzania
- Department of Epidemiology and Biostatistics Kilimanjaro Christian Medical University College Moshi Tanzania
- Department of Physiology Kilimanjaro Christian Medical University College Moshi Tanzania
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12
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Kurnick A, Zaveri S, Tadayoni A, Chandrakumar HP, John S. Reversible severe pulmonary hypertension and right heart failure with cardiogenic shock due to scurvy: a case report. Eur Heart J Case Rep 2023; 7:ytad404. [PMID: 37650076 PMCID: PMC10464571 DOI: 10.1093/ehjcr/ytad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
Background The systemic complications of vitamin C deficiency, otherwise known as scurvy, have been well-documented in history. Few case reports have documented severe cardiopulmonary complications such as right heart failure (RHF) and pulmonary hypertension (PH). Case summary A 25-year-old female presented to the hospital with two weeks of progressive fatigue, dyspnoea, myalgias, and arthralgias. She was admitted for symptomatic anaemia requiring transfusion. Her symptoms persisted and she developed severe PH and RHF, complicated by cardiogenic shock and multiple episodes of cardiac arrest. She was found to have severe vitamin C deficiency secondary to a severely self-restricted diet. After repletion of vitamin C, the patient had complete resolution of RHF and PH. Discussion This case adds to the sparse literature documenting severe cardiopulmonary complications of vitamin C deficiency. We believe that this is the first adult case of scurvy causing RHF and PH leading to cardiogenic shock and episodes of cardiac arrest. There are multiple hypotheses on the pathogenesis of scurvy-associated PH and RHF, including overactivation of hypoxia-inducible transcription factors and deficiency of vitamin C's vasodilatory effect that acts through increased nitric oxide production in endothelial cells. When recognized, early vitamin C repletion may prevent severe cardiopulmonary complications of scurvy.
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Affiliation(s)
- Adam Kurnick
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Sahil Zaveri
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Ashkan Tadayoni
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Harshith P Chandrakumar
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Sabu John
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
- Division of Cardiology, Kings County Hospital, 451 Clarkson Avenue, Brooklyn, NY 11203, USA
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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14
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Okada M, Nagayama Y, Saiki H, Ito K, Yatsuga S, Nagamitsu S. Selenium deficiency and scurvy due to an imbalanced diet of snacks and lacto-fermenting drinks: a case report of a 7-year-old boy with autism spectrum disorder. BMC Nutr 2023; 9:41. [PMID: 36890584 PMCID: PMC9993612 DOI: 10.1186/s40795-023-00703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND There have been reports of isolated trace elements or vitamin deficiencies due to imbalanced diets, but no cases of selenium deficiency combined with scurvy have been reported. CASE PRESENTATION A 7 year-old boy diagnosed with autistic spectrum disorder and mild psychomotor retardation, started an imbalanced diet including specific snacks and lacto-fermenting drinks from 5 years of age. Gingival hemorrhage and perioral erosions occurred at 6 years and 8 months of age, and he was referred to our hospital at 7 years of age. Slight tachycardia was found. Serum vitamin C level was 1.1 µg/dL (reference range (rr): 5-17.5 µg/dL), and selenium level was 2.8 µg/dL (rr: 7.7-14.8 µg/dL). He was diagnosed with both selenium deficiency and scurvy. Multivitamins and sodium selenate were administered for 12 days during admission, and symptoms of selenium deficiency and scurvy improved. After discharge, symptoms abated following the administration of multivitamins and regular administration of sodium selenate every 3 months. CONCLUSIONS We report a complicated case of both selenium deficiency and scurvy due to an imbalanced diet of snacks and lacto-fermenting drinks in a 7-year-old boy with autism spectrum disorder. In patients with imbalanced diet, regular blood tests including trace elements and vitamins are necessary.
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Affiliation(s)
- Makoto Okada
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yugo Nagayama
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hitomi Saiki
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kazutoshi Ito
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Shuichi Yatsuga
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Shinichiro Nagamitsu
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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15
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Firth PG, Benavidez OJ, Fiechtner L. The signs and symptoms of Ernest Shackleton. J Med Biogr 2023; 31:10-15. [PMID: 33896263 DOI: 10.1177/09677720211002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ernest Shackleton, an accomplished Antarctic explorer, developed a life-threatening illness during the Discovery Antarctic expedition of 1901-4. His documented signs and symptoms included inflamed gums attributed to scurvy, severe dyspnea, and exercise intolerance, presenting in a setting of nutritional deficiency. Physical examinations at a later date, also following a prolonged diet of limited fresh food, revealed a pulmonary systolic murmur. Thiamine deficiency with cardiomyopathy, either alone or subsequently exacerbated by advanced scurvy, may have been a prominent cause of Shackleton's condition.
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Affiliation(s)
- P G Firth
- Department of Anesthesia, Critical Care and Pain Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - O J Benavidez
- Department of Anesthesia, Critical Care and Pain Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - L Fiechtner
- Department of Anesthesia, Critical Care and Pain Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
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16
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Richier Q, Dalmas JB, Gaüzère L, Raffray L. A rare skin complication of COVID-19 pandemic. Rev Med Interne 2023; 44:201-202. [PMID: 36806478 PMCID: PMC9886658 DOI: 10.1016/j.revmed.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Q. Richier
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France,Corresponding author
| | - J.-B. Dalmas
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France
| | - L. Gaüzère
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France
| | - L. Raffray
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France,Inserm U1187, unité mixte processus infectieux en milieu insulaire tropical (PIMIT), CNRS 9192, IRD 249, plateforme technologique CYROI, université de La Réunion, 97490 Sainte-Clotilde, France
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17
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Ueki M, Sakamoto K, Nishioka N, Ohata H, Nobuta T, Takezaki S, Manabe A, Yamada M. Rheumatologic manifestations with elevated levels of IL-6, IL-17A, and IL-23 in a patient with scurvy. Mod Rheumatol Case Rep 2023; 7:302-306. [PMID: 35942728 DOI: 10.1093/mrcr/rxac059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 01/07/2023]
Abstract
Symptomatic vitamin C deficiency, scurvy, is a relatively rare disease in developed countries, but it has been reported in patients with autism spectrum disorder or developmental delay who tend to have selective diets. Patients with scurvy often demonstrate musculoskeletal manifestations with unknown pathophysiology. Herein, we report a case of scurvy in an 11-year-old boy who presented with iron-deficiency anaemia, systemic osteomyelitis, myositis predominantly in the lower extremities, and right ventricular volume overload with mild pulmonary hypertension and was diagnosed with scurvy. He had a mild developmental disorder and a selective diet, which resulted in severe vitamin C deficiency. He received intravenous and oral vitamin C supplementation, which relieved his arthralgia and muscle pain in a week. Following 4 months of vitamin C supplementation, he demonstrated no abnormal manifestations on laboratory or imaging examination and recovered without sequelae. Inflammatory cytokine and chemokine evaluations demonstrated elevated levels of interleukin (IL)-6, IL-17A, and IL-23, which are associated with T-helper (Th) 17 cell activation. This study is the first to suggest the association between the inflammation seen in scurvy, rheumatic manifestations in the patient, and Th17 cell activation. Further analysis of the association between the inflammation and vitamin C supplementation may contribute to new insights for the comprehension and treatment of other inflammatory diseases, such as rheumatic diseases.
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Affiliation(s)
- Masahiro Ueki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Keita Sakamoto
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| | - Noriko Nishioka
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| | - Hiroki Ohata
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takiko Nobuta
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | | | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.,Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan
| | - Masafumi Yamada
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.,Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaidô, Japan.,Department of Food and Human Wellness, Rakuno Gakuen University, Ebetsu, Japan
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18
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De Battista NA, Zammit MC, Soler SG, Attard S. Gait Disturbance … of Red Herrings, Oranges, and Lemons - A Case of Missed Vitamin C Deficiency and Lessons Learnt. Acta Medica (Hradec Kralove) 2023; 66:122-127. [PMID: 38511423 DOI: 10.14712/18059694.2024.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Vitamin C deficiency resulting in scurvy, is considered to be a rare nutritional disorder in developed countries, thus leading to underdiagnosis with exposure to unnecessary investigations and delay in appropriate treatment. The wide myriad of clinical signs and symptoms with which vitamin C deficiency can present (including haematological, musculoskeletal and vague constitutional symptoms that overlap with other common medical conditions), also contributes to this diagnostic challenge. Despite scurvy being habitually thought to be present in children with neurodevelopmental conditions such as autism spectrum disorder, other important at-risk groups that frequently tend to be forgotten include children with persistent fussy eating behaviour, and children with abnormal vitamin C metabolism. We hereunder present a case of a 10-year-old boy who presented to an acute general hospital for further investigation with gait disturbance. The lack of detailed nutritional assessment on presentation in the first instance led to a missed diagnosis of vitamin C deficiency, thus exposing the child to a wide array of unnecessary investigations and treatments. The added perplexity to the case resulting from false positive results of investigations performed as part of this child's workup, is also discussed.
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Affiliation(s)
| | | | | | - Stephen Attard
- Department of Child and Adolescent Health, Mater Dei Hospital Malta
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19
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Bertrand V, Millardet E, Bouchereau J, Dhenin C, Bruel H. Suspicion of Munchausen syndrome by proxy with a child's presentation of undernutrition, scurvy, and an apparent Avoidant Restrictive Food Intake Disorder. Eat Weight Disord 2022; 27:3815-3820. [PMID: 36565378 DOI: 10.1007/s40519-022-01520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Avoidant Restrictive Food Intake Disorder (ARFID) was recently characterized in the DSM-5 classification. Potential differential diagnoses remain poorly reported in the literature. Our purpose was to present a possible Munchausen syndrome by proxy with undernutrition and scurvy, presenting as ARFID in a child. METHODS We describe here a case of an 8-year-old boy who presented with severe undernutrition (BMI = 11.4) and scurvy leading to joint pains. The boy had had a very selective diet since early childhood, and his condition required hospitalization and enteral refeeding. Because of his specific eating behaviour, an ARFID was initially suspected. However, observation of the mother-child relationship, analysis of the child's eating behaviour, and retrospective analysis of his personal history suggested that this was not a true ARFID, and that the selective eating behaviour had probably been induced by the mother over many years, who probably maintained a low variety diet. CONCLUSION Munchausen syndrome by proxy is a difficult differential diagnosis, which may also affect patients with ARFID symptoms, which may also present in the affected child as apparent ARFID. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Valérie Bertrand
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France.
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.
| | - Ekatarina Millardet
- Child Radiology Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
| | - Juliette Bouchereau
- Reference Center for Inborn Error of Metabolism, Department of Paediatrics, Necker Hospital, Assistance Publique-Hôpitaux de Paris, G2M Network, MetabERN, Paris, France
| | - Caroline Dhenin
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
| | - Henri Bruel
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
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20
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Carroll M, Yoon J, Elliot P. Scurvy: Rare Orthopaedic Complications Associated with Multinutritional Deficiencies. Eur J Case Rep Intern Med 2022; 9:003359. [PMID: 36506738 PMCID: PMC9728213 DOI: 10.12890/2022_003359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Suboptimal nutrition can lead to deficiencies in micronutrients such as ascorbic acid (vitamin C), which can present with catastrophic neurological sequelae. Deficiencies of vitamin C, vitamin B3 (niacin) and zinc levels contribute to reduced bone density. Vitamin C associated vertebral fractures, although rare in adults, are still treatable if diagnosed early with a thorough clinical and nutritional history, and early supplementation. Radiological clues suggestive of scurvy-induced vertebral fractures can be diagnosed on plain X-ray and MRI spine imaging. LEARNING POINTS Although nutritional deficits like scurvy, pellagra and zinc deficiency are rare, early recognition and prompt treatment can prevent critical neurological sequelae.Clinical history including nutritional intake and associated patient symptoms are vital to diagnose scurvy-related vertebral fractures, which are treatable.It is important to note that scurvy can also present in an adult population.
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21
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Gordon BL, Galati JS, Yang S, Longman RS, Lukin D, Scherl EJ, Battat R. Prevalence and factors associated with vitamin C deficiency in inflammatory bowel disease. World J Gastroenterol 2022; 28:4834-4845. [PMID: 36156920 PMCID: PMC9476859 DOI: 10.3748/wjg.v28.i33.4834] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/23/2022] [Accepted: 08/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are prone to several nutritional deficiencies. However, data are lacking on vitamin C deficiency in Crohn’s disease (CD) and ulcerative colitis (UC) patients, as well as the impact of clinical, biomarker and endoscopic disease severity on the development of vitamin C deficiency.
AIM To determine proportions and factors associated with vitamin C deficiency in CD and UC patients.
METHODS In this retrospective study, we obtained clinical, laboratory and endoscopic data from CD and UC patients presenting to the IBD clinic at a single tertiary care center from 2014 to 2019. All patients had an available plasma vitamin C level. Of 353 subjects who met initial search criteria using a cohort discovery tool, 301 ultimately met criteria for inclusion in the study. The primary aim described vitamin C deficiency (≤ 11.4 μmol/L) rates in IBD. Secondary analyses compared proportions with deficiency between active and inactive IBD. Multivariate logistic regression analysis evaluated factors associated with deficiency.
RESULTS Of 301 IBD patients, 21.6% had deficiency, including 24.4% of CD patients and 16.0% of UC patients. Patients with elevated C-reactive protein (CRP) (39.1% vs 16.9%, P < 0.001) and fecal calprotectin (50.0% vs 20.0%, P = 0.009) had significantly higher proportions of deficiency compared to those without. Penetrating disease (P = 0.03), obesity (P = 0.02) and current biologic use (P = 0.006) were also associated with deficiency on univariate analysis. On multivariate analysis, the objective inflammatory marker utilized for analysis (elevated CRP) was the only factor associated with deficiency (odds ratio = 3.1, 95% confidence interval: 1.5-6.6, P = 0.003). There was no difference in the presence of clinical symptoms of scurvy in those with vitamin C deficiency and those without.
CONCLUSION Vitamin C deficiency was common in IBD. Patients with elevated inflammatory markers and penetrating disease had higher rates of vitamin C deficiency.
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Affiliation(s)
- Benjamin Langan Gordon
- Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United States
| | - Jonathan S Galati
- Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United States
| | - Stevie Yang
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Randy S Longman
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Dana Lukin
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Ellen J Scherl
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Robert Battat
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
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22
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Abstract
Scurvy, a disease caused by a severe lack of vitamin C in the diet, is most often associated with 17th-century sailors. Its 21st-century manifestation is a disease of the poor, sick, and those living in remote rural neighborhoods in which fresh, nutritious food is hard to come by. It is caused by a deficiency of Vitamin C and is rare in the United States. We describe the radiographic and MRI findings of a case of scurvy in a child with Noonan syndrome who is a "picky eater". MRI is rarely performed in scurvy as its radiographic findings are generally well known and sufficient for a diagnosis. However, due to the rarity of the disease in the US, MRI features of scurvy have been described in only a few case reports, to date. The rarity of this disease also causes scurvy to be kept lower, if at all in the differential diagnosis list.
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Affiliation(s)
- Som Biswas
- Department of Pediatric Radiology, LeBonheur Children's Hospital, UTHSC, Memphis, Tennessee, USA
| | - Stephen Miller
- Department of Pediatric Radiology, LeBonheur Children's Hospital, UTHSC, Memphis, Tennessee, USA
| | - Harris L Cohen
- Department of Pediatric Radiology, LeBonheur Children's Hospital, UTHSC, Memphis, Tennessee, USA
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23
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Schöller A, Géraud C. [Dermatologic manifestations of vitamin and mineral deficiency]. Dermatologie (Heidelb) 2022; 73:647-655. [PMID: 35925237 DOI: 10.1007/s00105-022-05029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Vitamin and mineral deficiency can lead to a wide variety of clinical symptoms. The skin, as a frequent site of manifestation of these diseases, can be a decisive cue for diagnosis. Deficiency occurs when micronutrients are insufficiently supplied to the organism, intestinal absorption is disturbed, or there are genetic defects that favor a deficiency. Predisposing factors and common triggers for diseases associated with deficiency in our latitudes are alcoholism, autism, psychiatric illnesses, eating disorders, special forms of nutrition (e.g., veganism), medications, gastrointestinal illnesses, bariatric surgeries, and periods of increased need (e.g., growth, pregnancy, lactation, infections). This article presents general and specific mucocutaneous changes that should suggest vitamin or mineral deficiency. Since vitamin C and zinc deficiency are among the deficiency dermatoses that cause characteristic skin symptoms, the symptoms of scurvy and acrodermatitis enteropathica are examined in more detail.
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Affiliation(s)
- Aline Schöller
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Cyrill Géraud
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
- Sektion für klinische und molekulare Dermatologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland.
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24
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Angeli AM, Megna B, Mazepa M, Ivy ZK, Sultan S, Sloan JA. Transfusion-dependent anemia secondary to vitamin C deficiency. Am J Hematol 2022; 97:E166-E167. [PMID: 35108411 PMCID: PMC8986622 DOI: 10.1002/ajh.26484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | - Bryant Megna
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition University of Minnesota Minneapolis Minnesota USA
| | - Marshall Mazepa
- Department of Medicine, Division of Hematology, Oncology, and Transplantation University of Minnesota Minneapolis Minnesota USA
| | - Zalaya K. Ivy
- Department of Medicine, Division of Hematology, Oncology, and Transplantation University of Minnesota Minneapolis Minnesota USA
| | - Shahnaz Sultan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition University of Minnesota Minneapolis Minnesota USA
| | - Joshua A. Sloan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition University of Minnesota Minneapolis Minnesota USA
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25
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Steyn M, van der Merwe AE, Meyer A. Infectious disease and nutritional deficiencies in early industrialized South Africa. Int J Paleopathol 2021; 33:128-136. [PMID: 33901884 DOI: 10.1016/j.ijpp.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Real industrialization was late to arrive in South Africa and was associated with the development of mining in its northern regions. This paper explores the development and spread of infectious diseases (particularly tuberculosis), against the backdrop of metabolic disease. MATERIALS Published data regarding skeletons from various mining sites and historical information are collated, including information from the early accessions into the Raymond A. Dart Collection. METHODS While findings from several sites (e.g., Gladstone at Kimberley, Koffiefontein, Witwatersrand Deep Mine and Lancaster Mine) have been described individually, they have not been assessed collectively. This paper provides a broad overview by collating information from these sites, in comparison with a rural, pre-industrialized population. RESULTS Malnutrition, including scurvy, was common in most mining groups. Tuberculosis was rare in earlier mining groups, and the first possible skeletal cases only occurred after the establishment of closed housing compounds. From there it spread rapidly across the subcontinent. CONCLUSIONS Nutritional insufficiencies / metabolic disease and high death rates, due to trauma and infectious diseases, were common. Tuberculosis in South Africa is closely associated with development of the mining industry. SIGNIFICANCE This research highlights the development of tuberculosis in South Africa and its association with the mining industry. The role of migrant labor and the associated housing practices is elucidated. LIMITATIONS Sample sizes are limited, but the findings of this study are supported by documentary evidence. FUTURE RESEARCH Sample sizes should be increased, and the association between closed compound living and the development of disease further explored.
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Affiliation(s)
- M Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - A E van der Merwe
- Department of Medical Biology, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, The Netherlands
| | - A Meyer
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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26
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Perry MA, Edwards E. Differential diagnosis of metabolic disease in a commingled sample from 19th century Hisban, Jordan. Int J Paleopathol 2021; 33:220-233. [PMID: 34004547 DOI: 10.1016/j.ijpp.2021.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This research attempts a differential diagnosis of skeletal lesions in a commingled sample from Hisban, Jordan, focusing on non-adults in the assemblage. MATERIALS 2,883 well-preserved skeletal elements and 9 relatively complete skulls representing an MNI of 32 non-adults (<18 years old). METHODS All skeletal elements were observed macroscopically and pathophysiological processes underlying any lesions or other anomalies were assessed, followed by a comparative approach to rule out potential diagnoses. RESULTS The skeletal lesions observed were caused by inflammation due to chronic hemorrhaging, marrow hyperplasia due to an increase in hemopoiesis, rapid bone growth, and the impact of biomechanical strain on poorly mineralized elements. Rickets, scurvy, and acquired anemias best fit this pattern of lesions, although inflammation from other sources such as trauma or infection could not be definitively ruled out. CONCLUSIONS The in utero and postnatal environments at Hisban were conducive to the development of vitamin C and D deficiencies from birth until 2 years of age. The analysis of commingled remains requires an ontological shift in the importance of the individual to the population in paleopathology. SIGNIFICANCE This investigation demonstrates the efficacy of a combined biological and comparative approach in differential diagnosis in complicated commingled collections. In addition, it emphasizes the importance of the mother-infant dyad in understanding metabolic disease. LIMITATIONS Histological and radiographic analyses were not included in this diagnostic study due to COVID-19 travel restrictions. SUGGESTIONS FOR FURTHER RESEARCH Isotopic analysis to investigate childhood diet and histological and radiographic analyses to assess survival of deficiencies.
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Affiliation(s)
- Megan A Perry
- Department of Anthropology, East Carolina University, Greenville, NC, 27858, USA.
| | - Emily Edwards
- Department of Anthropology, East Carolina University, Greenville, NC, 27858, USA
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27
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Musa H, Ismail II, Abdul Rashid NH. Paediatric scurvy: frequently misdiagnosed. Paediatr Int Child Health 2021; 41:158-161. [PMID: 32937094 DOI: 10.1080/20469047.2020.1816285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Paediatric scurvy is uncommon in the modern age but cases have been reported in children with neurodevelopmental issues and restricted dietary habits. The broad clinical picture is frequently overlooked as primarily other systemic diseases are considered first leading to extensive investigations and delay in diagnosis. A 4-year-old boy with autism and bilateral lower limb pain and refusal to walk is reported. His restricted diet and radiographic findings were highly suggestive of scurvy which was confirmed by the extremely low levels of ascorbic acid. Treatment with ascorbic acid replenishment and maintenance resulted in remarkable improvement. This case highlights the importance of a high index of suspicion in at-risk children so as to avoid unnecessary invasive investigations and procedures.
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Affiliation(s)
- Husna Musa
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Paediatrics, Serdang Hospital, Ministry of Health, Serdang, Malaysia
| | - Imma Isniza Ismail
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurul Hazwani Abdul Rashid
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Paediatrics, Serdang Hospital, Ministry of Health, Serdang, Malaysia
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Abstract
We present a rare case of pediatric scurvy in a 9-year-old male who presented with nontraumatic knee pain. MRI was obtained due to the puzzling presentation. MRI demonstrated a systemic bone marrow abnormality which led to a conversation with the clinician and further elucidation of an extremely narrow diet lacking sufficient vitamin C (ascorbic acid). Diagnosis was confirmed biochemically with undetectable ascorbic acid level and clinically with compatible exam and history. This case highlights a thought process for unexpected bone marrow abnormality on MRI.
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Affiliation(s)
- Alec Ganske
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Amy B Kolbe
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Kristen Thomas
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
| | - Nathan Hull
- Division of Radiology, Mayo Clinic, 200 1st St SW; Rochester, MN 55905, USA
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29
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Guellich A, Tella E, Mahé E. [ Scurvy presenting with low-extremity necrotic and purpuric ulcers: Two cases]. Rev Med Interne 2020; 42:214-217. [PMID: 33203540 DOI: 10.1016/j.revmed.2020.10.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scurvy is a clinical syndrome resulting from ascorbic acid deficiency. Although presently rare in the developed world, it continues to occur within certain susceptible populations, particularly the elderly and those with dietary habits with low vitamin C intake. CASES Two men aged 87 and 69 were referred with multifactorial, progressive ulceration of the lower limbs, without scarring, in a context of arterial disease and other associated comorbidities. In both cases, the level of vitamin C was undetectable. An improvement in the necrotic component and in the purpura was promptly observed after vitamin C supplementation. CONCLUSIONS Diagnosis of scurvy can be challenging. This report highlights the importance of maintaining a high index of suspicion for scurvy in atypical necrotic ulcerations of lower extremities with poor response to standard therapy especially in populations at high risk of vitamin C deficiency. Early diagnosis can improve patient prognosis.
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Affiliation(s)
- A Guellich
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France
| | - E Tella
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France
| | - E Mahé
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France.
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30
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Yule S, Wanik J, Holm EM, Bruder MB, Shanley E, Sherman CQ, Fitterman M, Lerner J, Marcello M, Parenchuck N, Roman-White C, Ziff M. Nutritional Deficiency Disease Secondary to ARFID Symptoms Associated with Autism and the Broad Autism Phenotype: A Qualitative Systematic Review of Case Reports and Case Series. J Acad Nutr Diet 2020; 121:467-492. [PMID: 33221247 DOI: 10.1016/j.jand.2020.10.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The demographics, weight statuses, and dietary patterns of people with autism or the broad autism phenotype who experience a severe nutrient deficiency disease due to symptoms of avoidant/restrictive food intake disorder have not been well established. OBJECTIVE The primary objective of this review was to examine the relationship between the demographics, weight statuses, dietary patterns, and nutrient deficiency diseases that characterize the most severe manifestations of avoidant/restrictive food intake disorder symptomology associated with autism or the broad autism phenotype. METHODS A systematic review of English and non-English articles published up to August 29, 2019, on the Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature Plus electronic databases was conducted. Additional cases were identified through the reference list of all included articles. The search terms used were "autis∗ AND (deficiency OR scurvy)". Only case reports or case series in which a person of any age who had been identified as having a formal diagnosis of autism or autism symptoms and a disease of nutritional deficiency due to self-imposed dietary restrictions were included. Data were independently extracted by 8 authors using predefined data fields. RESULTS A total of 76 cases (patients were aged 2.5 to 17 years) from 63 articles that were published from 1993 through 2019 were found. More than 85% cases (65 of 76 patients) were from articles published in the past 10 years. The largest percentage of published cases (69.7% [53 of 76]) involved scurvy, a vitamin C deficiency. The second-largest percentage of published cases (17.1% [13 of 76]) involved eye disorders secondary to vitamin A deficiency. Other primary nutrient deficiencies reported were thiamin, vitamin B-12, and vitamin D. In 62.9% (22 of 35) of the patients for which a body mass index or a weight percentile for age was provided, the patient was within normal weight parameters, per Centers for Disease Control weight status categories. CONCLUSIONS Based on the 63 articles extracted for this systematic review, nutritional deficiency diseases related to inadequate intakes of vitamin A, thiamin, vitamin B-12, vitamin C, and vitamin D were found in individuals with autism and the broad autism phenotype who had severe self-imposed dietary restrictions. When weight information was provided, most of the youth in these cases were not reported to be underweight. Individuals of any weight who present with symptoms of avoidant/restrictive food intake disorder can benefit from early and frequent screening for adequacy of micronutrient intake, regardless of whether they have a clinical diagnosis of autism.
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31
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Cheudjeu A. Correlation of D-xylose with severity and morbidity-related factors of COVID-19 and possible therapeutic use of D-xylose and antibiotics for COVID-19. Life Sci 2020; 260:118335. [PMID: 32846167 PMCID: PMC7443215 DOI: 10.1016/j.lfs.2020.118335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023]
Abstract
The SARS-Cov-2 pandemic that currently affects the entire world has been shown to be especially dangerous in the elderly (≥65 years) and in smokers, with notably strong comorbidity in patients already suffering from chronic diseases, such as Type 2 diabetes, cancers, chronic respiratory diseases, obesity, and hypertension. Inflammation of the lungs is the main factor leading to respiratory distress in patients with chronic respiratory disease and in patients with severe COVID-19. Several studies have shown that inflammation of the lungs in general and Type 2 diabetes are accompanied by the degradation of glycosaminoglycans (GAGs), especially heparan sulfate (HS). Several studies have also shown the importance of countering the degradation of HS in lung infections and Type 2 diabetes. D-xylose, which is the initiating element for different sulfate GAG chains (especially HS), has shown regeneration properties for GAGs. D-xylose and xylitol have demonstrated anti-inflammatory, antiglycemic, antiviral, and antibacterial properties in lung infections, alone or in combination with antibiotics. Considering the existing research on COVID-19 and related to D-xylose/xylitol, this review offers a perspective on why the association between D-xylose and antibiotics may contribute to significantly reducing the duration of treatment of COVID-19 patients and why some anti-inflammatory drugs may increase the severity of COVID-19. A strong correlation with scurvy, based on gender, age, ethnicity, smoking status, and obesity status, is also reviewed. Related to this, the effects of treatment with plants such as Artemisia are also addressed. CHEMICAL COMPOUNDS: D-xylose; xylitol; l-ascorbic Acid; D-glucuronic acid; N-acetylglucosamine; D-N-acetylglucosamine; N-acetylgalactosamine; galactose.
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32
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Roy-Lavallee J, Bahrani B, Weinstein M, Katzman DK. Scurvy: An Unexpected Nutritional Complication in an Adolescent Female With Anorexia Nervosa. J Adolesc Health 2020; 67:618-620. [PMID: 32291151 DOI: 10.1016/j.jadohealth.2020.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 10/24/2022]
Abstract
Vitamin C deficiency results in the clinical presentation of scurvy, a disease that is rare among the adolescent population. Individuals with unusual dietary habits, mental illness, or physical disability are more prone to develop scurvy. We present a case report of a previously healthy 16-year-old female presented to the hospital with a 12-month history of anorexia nervosa, restrictive subtype. She was admitted to the intensive care unit and transferred to a tertiary care pediatric eating disorder program for the treatment of extreme weight loss, cardiovascular instability, and refeeding syndrome. On examination, she had multiple tiny hyperpigmented perifollicular petechial papules on the lower abdomen, dorsum thighs, and extensor surfaces of the arms with corkscrew hairs on the abdomen. Dermatologic examination and laboratory investigations were consistent with a diagnosis of scurvy. The patient's vitamin C serum level was 21 μmol/L (.23 mg/dL; reference range 25-114 μmol/L [.28-1.28 mg/dL]). She was treated with ascorbic acid orally. Objective cutaneous findings improved within 4 weeks of supplementation, and after 6 weeks, repeat levels of vitamin C levels were 102 μmol/L (1.15 mg/dL). To the best of our knowledge, this is the first case of an adolescent female with anorexia nervosa and cutaneous manifestations of scurvy that resolved after the oral administration of vitamin C.
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Affiliation(s)
- Julien Roy-Lavallee
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
| | | | - Miriam Weinstein
- University of Toronto, Toronto, Canada; Division of Paediatric Medicine (Dermatology), Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada; Research Institute, Hospital for Sick Children, Toronto, Canada.
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33
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Diab Shehade K, Lamdan R, Aharoni D, Yeshayahu Y. "What can you C in a limping child?" Scurvy in an otherwise healthy "picky eater". Nutrition 2021; 82:111019. [PMID: 33109452 DOI: 10.1016/j.nut.2020.111019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022]
Abstract
We present a case of an otherwise healthy 3-year-old child who presented with limping, bone pain, fatigue, and agitation. Differential diagnosis included an infection of the bone, malignancy, an inflammatory bone disease, and metabolic bone disease. Magnetic resonance imaging of the lower limbs and the spine was consistent with scurvy, and the diagnosis was confirmed by very low levels of vitamin C. Further history taking revealed a diet based entirely on dairy pudding, with no fruits or vegetables, and being a "picky eater" was the sole reason. Intravenous treatment with vitamin C led to full recovery. Previous reports of scurvy were in patients with other medical conditions, such as malabsorption, or behavioral conditions as in autism. This case demonstrates that scurvy, an almost forgotten condition from past centuries, can occur in otherwise healthy children and should raise awareness regarding the importance of a balanced diet and proper nutritional history taking. Following growth charts as the only screening tool for balanced and inclusive nutrition may not be sufficient.
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34
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Lescuyer S, Meyer A, Weber JC. A spontaneous hematoma in a healthy young woman. Eur J Intern Med 2020; 79:108-109. [PMID: 32653153 DOI: 10.1016/j.ejim.2020.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Sylvain Lescuyer
- Internal Medicine Department, Strasbourg University Hospital, 1 Place de l'hôpital BP 426 67091 Strasbourg cedex, France, +33 3 69 55 05 02.
| | - Aurore Meyer
- Clinical Immunology Department, Strasbourg University Hospital, 1 Place de l'hôpital BP 426 67091 Strasbourg cedex, France, +33 3 69 55 05 21
| | - Jean-Christophe Weber
- Internal Medicine Department, Strasbourg University Hospital, 1 Place de l'hôpital BP 426 67091 Strasbourg cedex, France, +33 3 69 55 05 02
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35
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Abstract
In May 1845 HMS Terror and HMS Erebus left England under the command of Sir John Franklin to find the Northwest Passage linking the north Atlantic and Pacific Oceans. The ships had been specially equipped for arctic conditions with central heating, auxiliary steam engines and reinforced steel bows to cut through the ice, however, despite these modern additions neither the vessels nor any of the 129 crew members would ever return. Recently the wrecks of the ships have been located in the waters around King William Island, Nunavut, Canada. Numerous theories have been advanced to explain the deaths that involve lead poisoning, scurvy and zinc deficiency. It is most likely, however, that the deaths were the result of multiple factors such as starvation, hypothermia, infection and general physical and mental decline. Cannibalism occurred but whether this involved the use of already dead sailors or the culling of the weak for food is not determinable. The essential point is that the crews were trapped in the Arctic, many thousands of miles from their homes and families, with dwindling food supplies and minimal chances of rescue.
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Affiliation(s)
- Roger W Byard
- Adelaide School of Medicine, The University of Adelaide, Level 2 Helen Mayo North Building, Frome Road, Adelaide, SA, 5005, Australia.
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36
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Abstract
BACKGROUND Vitamin C deficiency may be more common than is generally assumed, and the association between vitamin C deficiency and adverse psychiatric effects has been known for centuries. This paper aims to systematically review the evidence base for the neuropsychiatric effects of vitamin C deficiency. METHODS Relevant studies were identified via systematic literature review. RESULTS Nine studies of vitamin C deficiency, including subjects both with and without the associated physical manifestations of scurvy, were included in this review. Vitamin C deficiency, including scurvy, has been linked to depression and cognitive impairment. No effect on affective or non-affective psychosis was identified. CONCLUSIONS Disparate measurement techniques for vitamin C, and differing definitions of vitamin C deficiency were apparent, complicating comparisons between studies. However, there is evidence suggesting that vitamin C deficiency is related to adverse mood and cognitive effects. The vitamin C blood levels associated with depression and cognitive impairment are higher than those implicated in clinical manifestations of scurvy. While laboratory testing for ascorbic acid can be practically difficult, these findings nonetheless suggest that mental health clinicians should be alerted to the possibility of vitamin C deficiency in patients with depression or cognitive impairment. Vitamin C replacement is inexpensive and easy to deliver, although as of yet there are no outcome studies investigating the neuropsychiatric impact of vitamin C replacement in those who are deficient.
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Affiliation(s)
- David Plevin
- Central Adelaide Local Health Network, Adelaide, SA, Australia. .,Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia. .,Ramsay Health Care Mental Health, Gilberton, SA, Australia.
| | - Cherrie Galletly
- grid.1010.00000 0004 1936 7304Discipline of Psychiatry, The University of Adelaide, Adelaide, SA Australia ,Northern Adelaide Local Health Network, Adelaide, SA Australia
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37
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Klaus HD. Metabolic diseases in Andean paleopathology: Retrospect and prospect. Int J Paleopathol 2020; 29:54-64. [PMID: 31377145 DOI: 10.1016/j.ijpp.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/01/2019] [Accepted: 06/29/2019] [Indexed: 06/10/2023]
Abstract
John Verano's 1997 synthesis of Andean paleopathology guided two decades of research and was instrumental in establishing modern Andean paleopathology. This paper reviews the current state and new directions in the study of skeletal metabolic disorders in the Central Andean archaeological record. Key historical, ecological, methodological, and contextual issues intersect with the study of metabolic bone diseases in Andean paleopathology. This paper further examines known temporal and spatial distribution of these disorders, as well as the strengths and weaknesses of the record of linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, scurvy, and rickets. Many other metabolic bone diseases have yet to be documented such as pellagra, hypophosphatasia, osteomalacia, and mucopolysaccharidosis among others. This work closes with considerations in the search for these undocumented diseases, but such an effort is only one part of new wave of advancements just on the horizon. The study of metabolic diseases in Andean paleopathology can lead the development of more sophisticated approaches to data collection, analysis, and interpretation - especially regarding theoretical interpretations from various bodies of social theory to the Developmental Origins of Health and Disease hypothesis, life history approaches, and phenotypic adaptive plasticity and constraint.
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Affiliation(s)
- Haagen D Klaus
- Department of Sociology and Anthropology, George Mason University, United States; Museo Nacional Sicán, Peru; Museo Nacional de Arqueología y Etnografía Hans Heinrich Brüning de Lambayeque, Peru.
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38
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Alten ED, Chaturvedi A, Cullimore M, Fallon AA, Habben L, Hughes I, O'Malley NT, Rahimi H, Renodin-Mead D, Schmidt BL, Weinberg GA, Weber DR. No longer a historical ailment: two cases of childhood scurvy with recommendations for bone health providers. Osteoporos Int 2020; 31:1001-1005. [PMID: 31901946 PMCID: PMC7383933 DOI: 10.1007/s00198-019-05264-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Scurvy, due to vitamin C deficiency, is commonly referenced as a "forgotten" or "historical" disease. A growing number of case reports challenge this notion. Bone health providers are often consulted early in the presentation of scurvy to evaluate musculoskeletal complaints resulting from impaired collagen production and disrupted endochondral bone formation. In this report, we describe two cases of childhood scurvy. Our objective is to summarize the key features of scurvy for bone health providers, with the goal of raising awareness and facilitating diagnosis in future cases. CASE DESCRIPTIONS Case one occurred in a 12-year-old non-verbal, non-ambulatory female on a ketogenic diet for refractory epilepsy. Clinical findings included hemarthrosis, transfusion dependent anemia, elevated inflammatory markers, and epiphysiolysis. Magnetic resonance imaging (MRI) revealed multi-focal bone marrow signal abnormalities and physeal irregularities. Case two occurred in a typically developing 5-year-old male presenting with limp and knee pain. Symptoms progressed despite casting and immobilization. Mild anemia, elevated inflammatory markers, and multi-focal marrow and physeal MRI abnormalities were identified. Subsequent dietary history revealed total absence of fruit or vegetable consumption. The diagnosis of scurvy was confirmed in both cases by undetectable plasma vitamin C concentrations. Treatment with vitamin C led to rapid clinical improvement. CONCLUSION Scurvy can no longer be considered a historical diagnosis and should not be forgotten when evaluating children with musculoskeletal ailments. Early recognition of the signs, symptoms, and imaging findings of scurvy can reduce the clinical burden of this disease with the timely initiation of vitamin C therapy.
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Affiliation(s)
- E D Alten
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - A Chaturvedi
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - M Cullimore
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - A A Fallon
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - L Habben
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - I Hughes
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - N T O'Malley
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - H Rahimi
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - D Renodin-Mead
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
- Oak Orchard Community Health Center Inc., Brockport, NY, USA
| | - B L Schmidt
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - G A Weinberg
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - D R Weber
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA.
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Schwetje D, Zillekens A, Kieback JD, Koob S, Placzek R. Infantile scurvy: Still a relevant differential diagnosis in Western medicine. Nutrition 2020; 75-76:110726. [PMID: 32247222 DOI: 10.1016/j.nut.2020.110726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 10/31/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Infantile scurvy or Moller-Barlow's disease appears to be of no further importance in Western countries; however, this is a careless assumption. In severely disabled children especially, this malady manifests itself in a broad range of symptoms such as delayed or suppressed bone healing, minor traumatization leading to bruises or fractures, and epiphysiolysis. METHODS The aim of this article was to present the required daily uptake of vitamin C and the biochemical pathways in the human body leading to the typical symptoms of scurvy. Two cases of chronic scurvy with prolonged bone healing and bleeding, epiphysiolysis, and gingival hyperplasia are presented. Both patients were chronically ill with one having cerebral palsy and the other a neuroblastoma of the adrenal gland. RESULTS After diagnosis, the substitution of vitamin C via percutaneous endoscopic gastrostomy in both patients was necessary to treat them. Both patients quickly achieved a full recovery. CONCLUSION The two patients presented show the importance of infantile scurvy in daily medical care. The prevalence of scurvy is often underestimated in severely disabled or chronically ill children.
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Affiliation(s)
- Desirée Schwetje
- University Hospital Bonn, Department of Orthopedics and traumatology, Bonn, Germany.
| | - Anne Zillekens
- University Hospital Bonn, Department of Orthopedics and traumatology, Bonn, Germany
| | - Jan-Dirk Kieback
- University Hospital Bonn, Department of Orthopedics and traumatology, Bonn, Germany
| | - Sebastian Koob
- University Hospital Bonn, Department of Orthopedics and traumatology, Bonn, Germany
| | - Richard Placzek
- University Hospital Bonn, Department of Orthopedics and traumatology, Bonn, Germany
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40
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Snoddy AME, Beaumont J, Buckley HR, Colombo A, Halcrow SE, Kinaston RL, Vlok M. Comment on Charlier et al., 2019: "The Mandible of Saint-Louis (1270 AD): Retrospective diagnosis and circumstances of death". J Stomatol Oral Maxillofac Surg 2020; 121:192-4. [PMID: 31904527 DOI: 10.1016/j.jormas.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/20/2019] [Indexed: 11/23/2022]
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Abstract
INTRODUCTION Scurvy is a rare condition in pediatric patients, resulted from a vitamin C deficiency. Musculoskeletal symptoms occur in 80% of patient. The rarity and the polymorphisms of the clinical signs and symptoms often make scurvy an unknown or forgotten diagnosis. METHODS A 3-years-old boy with limping gait, progressive pain and swelling on his left lower limb since 3 months prior was diagnosed as osteomyelitis based on MRI. When there was no improvement after 2 weeks of IV antibiotic administration, we did surgical debridement procedure. Intraoperative, we found extensive blood clot inside and in the entire periosteum instead of infection. One week after surgery, there was still no improvement clinically and radiographically. Histopathology result suggested a fibro-osseous tumor. After reviewing clinical sign including skin presentation and plain radiology, we suspected scurvy disease in this patient and started a vitamin C therapy course immediately. RESULTS Two weeks after we started vitamin C treatment, the patient's condition was significantly improved clinically and radiographically. Serial radiograph was taken after 2 and 12 months of surgery, and it showed significant improvement on the site where the previous pathological process appeared. DISCUSSIONS Because of the extremely rare occurrence of scurvy in modern society at present, it is difficult to differentiate it from other diseases such as infection. The diagnosis of scurvy is made by careful studies from history taking, physical examination, laboratory and especially radiological finding that show pathognomonic appearance. Examination of vitamin C level serum is a gold standard, but unfortunately not available in our country. Improvement after vitamin C administration also established that condition. CONCLUSION Scurvy should have established by clinical and radiological findings that show pathognomonic signs around joint, even without supported by vitamin C serum.
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Affiliation(s)
- Faisal Miraj
- Department of Orthopaedic - Traumatology, Fatmawati General Hospital, Indonesia.
| | - Ali Abdullah
- Department of Orthopaedic - Traumatology, Faculty of Medicine Universitas, Indonesia
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Billoir P, Feugray G, Chrétien MH, Fresel M, Le Cam Duchez V. [Bloody tears: About a case and a review of the literature]. Rev Med Interne 2019; 41:339-342. [PMID: 31882188 DOI: 10.1016/j.revmed.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/25/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hemolacria is a rare hemorrhagic syndrome characterized by bloody tears. The most common etiologies are inflammation, infection or laceration. However, other rarer diseases may also cause this clinical manifestation. CASE REPORT We describe the case of a 14-year-old male patient hospitalized for hemolacria. A history of von Willebrand disease was present in his family, diagnosed in his mother and sister, but absent in our patient. A vitamin C dosage was obtained in our patient and revealed scurvy consecutive to malnutrition. After having excluded other bleeding symptoms like bruises we retained vitamin C deficiency as the etiology of the hemorrhagic syndrome. CONCLUSION Bloody tears are a rare clinical manifestation and the etiology may be difficult to determine. Bloody tears are a rare clinical manifestation of hemorrhagic syndrome. To determine the underlying etiology, screening should consider all possible causes including the rarest.
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Affiliation(s)
- P Billoir
- Vascular hemostasis unit, Normandie Univ, UNIROUEN, Inserm U1096, Rouen university hospital, 76000 Rouen, France.
| | - G Feugray
- Vascular hemostasis unit, Rouen university hospital, 76000 Rouen, France
| | - M H Chrétien
- Vascular hemostasis unit, Rouen university hospital, 76000 Rouen, France
| | - M Fresel
- Vascular hemostasis unit, Rouen university hospital, 76000 Rouen, France
| | - V Le Cam Duchez
- Vascular hemostasis unit, Normandie Univ, UNIROUEN, Inserm U1096, Rouen university hospital, 76000 Rouen, France
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43
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Gach MW, Rudra R, Smith RW. Images of the month 1: 'The scurvy' - diagnosis by gestalt. Clin Med (Lond) 2019; 19:526-527. [PMID: 31732599 PMCID: PMC6899258 DOI: 10.7861/clinmed.2019-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael W Gach
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rathiga Rudra
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Richard W Smith
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
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Saavedra MJ, Aziz J, Cacchiarelli San Román N. Scurvy due to restrictive diet in a child with autism spectrum disorder: case report. ARCH ARGENT PEDIATR 2019; 116:e684-e687. [PMID: 30204999 DOI: 10.5546/aap.2018.eng.e684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/18/2018] [Indexed: 11/12/2022]
Abstract
Scurvy is a very uncommon entity in pediatric population. Some case reports have been published in infants fed with boiled milk, in patients with iron overload secondary to hematological diseases and in children with food restrictions secondary to neurodevelopmental disorders. We report a case of a 4-year-old male patient with a diagnosis of autism spectrum disorder, which developed scurvy secondary to a long-term selective eating habit without fruit or vegetable intake. The objective of this case report is to announce the pediatrician and other professionals dedicated to primary health care about scurvy as a potential consequence of restrictive diets in children with autism spectrum disorders as well as the importance of dietary history in sick patients to prevent associated micronutrient deficiencies.
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Affiliation(s)
- Melina J Saavedra
- Departamento de Pediatría, Servicio de Clínica Pediátrica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires.
| | - Julieta Aziz
- Departamento de Pediatría, Servicio de Clínica Pediátrica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
| | - Nicolás Cacchiarelli San Román
- Departamento de Pediatría, Servicio de Clínica Pediátrica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
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Sun L, Pechenkina K, Cao Y, Zhang H, Qi X. Cases of endocranial lesions on juvenile skeletons from Longshan cultural sites in Henan Province, China. Int J Paleopathol 2019; 26:61-74. [PMID: 31252199 DOI: 10.1016/j.ijpp.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 06/09/2023]
Abstract
Endocranial lesions were recognized on eight out of the 31 juveniles (25.8%) that were recovered from three Neolithic archaeological sites in Henan province. The remains of juveniles were recovered from urn burials at the Jiazhuang site (2200-2030 BCE) and graves at the Pingliangtai (2300-2100 BCE) and Haojiatai sites (2448-1700 BCE). The presence of endocranial lesions on all eight of these juvenile skulls was associated with a range of lesions on other bones, including areas of abnormal porosity and subperiosteal new bone deposition on either the sphenoid, maxilla, mandibular ramus, or orbit, as well as subperiosteal lesions on the postcranial bones. Several plausible explanations for the formation of these endocranial lesions in our eight cases include scurvy, shaken baby syndrome, and intrathoracic disease (such as tuberculosis or pulmonary infection). We show that the presence of endocranial lesions had a strong correspondence with skeletal markers of dietary deficiency, i.e. scurvy, and in one case, anemia. Millet was a key component of the Longshan subsistence in the area, while paleobotanical evidence of fruit and leafy vegetables appears to be limited, likely resulting in a nutrient deficient diet. The coupling of endocranial lesions with skeletal signs of dietary deficiency can be direct, as scurvy favors hemorrhaging, or mediated by physiological or sociocultural factors, and thereby represents comorbidity.
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Affiliation(s)
- Lei Sun
- Henan Provincial Institute of Cultural Heritage and Archaeology, Zhengzhou, Henan, China.
| | - Kate Pechenkina
- Department of Anthropology, Queens College of the City University of New York, New York, USA.
| | - Yanpeng Cao
- Henan Provincial Institute of Cultural Heritage and Archaeology, Zhengzhou, Henan, China
| | - Hai Zhang
- School of Archaeology and Museology, Beijing University, Beijing, China
| | - Xueyi Qi
- Zhumadian Municipal Administration of Cultural Relics and Archaeology, Zhumadian, Henan, China
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Abstract
Background Scurvy is one of the oldest diseases known to mankind. Although presently rare in the developed world, scurvy was a common potentially fatal disease. In recent times, the most common risk factors for scurvy include alcoholism, low socioeconomic status, and severely poor nutrition or dietary restriction secondary to psychiatric illness or developmental disorders. Our case demonstrates the importance of having a high index of clinical suspicion of an uncommon disease in developed countries and emphasizes the necessity of a dietary screening that could potentially reduce extensive work-up in patients with nonspecific complaints. Case presentation We report a case of a 3-year-old previously healthy female originally seen in the rheumatology clinic for limp. She developed weakness and was admitted to the hospital for further evaluation. She underwent extensive diagnostic testing including blood work, magnetic resonance imaging, lumbar puncture, electromyogram, and nerve conduction studies. Ultimately, her vitamin C level returned undetectable. She had immediate and complete improvement upon starting vitamin C supplementation. Conclusions Despite being developmentally appropriate, our patient’s refusal to eat fruits or vegetables had limited her diet, emphasizing the importance of obtaining a diet history in a child presenting with an unknown diagnosis. In addition, our patient had no other characteristic features of scurvy, which further supports the need to consider this diagnosis in a child presenting with lower extremity weakness or abnormal gait.
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Affiliation(s)
- Robin M Lund
- University of Louisville School of Medicine, 571 S. Floyd Street, Suite 412, Louisville, KY, 40202, USA
| | - Mara L Becker
- Duke Clinical Research Institute, 200 Morris Street, Durham, North Carolina, 27701, USA
| | - Steven Shapiro
- Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Tyler Allison
- Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Julia G Harris
- Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Charlier P, Augias A, Benmoussa N, Rainsard P, Froesch P, Richardin P, Froment A, Bianucci R, Appenzeller O, Perciaccante A, Lippi D, Prades L. The mandible of Saint-Louis (1270 AD): Retrospective diagnosis and circumstances of death. J Stomatol Oral Maxillofac Surg 2019; 121:172-174. [PMID: 31185300 DOI: 10.1016/j.jormas.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/19/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Recent paleopathological cases have shown the usefulness of interdisciplinary odontological studies in the investigation of historical figures. OBSERVATION A macroscopic examination of the mandible of Saint-Louis (13th c. AD), conserved in the cathedral of Notre-Dame (Paris, France) was carried out, and compared with biographical data about the life and death of the King, and contemporaneous cases of infectious/inflammatory diseases. We found post-mortem tooth loss associated with moderate signs of infectious and inflammatory diseases, which precise diagnoses are discussed facing historical chronicles and sources: main diagnosis is scurvy, potentially associated with bacterial infection. DISCUSSION Our results support the identification of the relics, and improve the knowledge about the saint's circumstances of death related to metabolic deficiencies and infections.
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Affiliation(s)
- P Charlier
- Musée du quai Branly-Jacques-Chirac, 222, rue de l'Université, 75007 Paris, France; UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France.
| | - A Augias
- UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - N Benmoussa
- UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - P Rainsard
- UVSQ (DANTE Laboratory, EA 4498), UFR of Health Sciences, 2, avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | | | - P Richardin
- Centre de restauration et de recherche des musées de France, Paris, France
| | - A Froment
- National Museum of Natural History, Paris, France
| | - R Bianucci
- Legal Medicine Section, Department of Public Health and Pediatric Sciences, University of Turin, Italy
| | - O Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, 361, Big Horn Ridge Dr. NE, Albuquerque, NM, USA; New Mexico Museum of Natural History and Science, 1801, Mountain Road NW, Albuquerque, NM, USA
| | - A Perciaccante
- Department of Medicine, "San Giovanni di Dio" Hospital, Gorizia, Italy
| | - D Lippi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - L Prades
- Cathedral of Notre-Dame de Paris, Paris, France
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48
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Joshi R, Gustas-French CN, Fanburg-Smith JC, Helm KF, Flemming D. Scurvy: a rare case in an adult. Skeletal Radiol 2019; 48:977-84. [PMID: 30259130 DOI: 10.1007/s00256-018-3069-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 02/02/2023]
Abstract
A 69-year-old man presented with unilateral calf pain, swelling, and erythematous rash. He was initially treated with antibiotics for suspected cellulitis. A venous duplex ultrasound, performed to exclude deep venous thrombosis, revealed multiple heterogeneous hypoechoic foci of unknown etiology throughout the calf musculature. His condition did not improve with antibiotics, instead progressing to a necrotic ulcer along the medial malleolus. Clinical suspicion of vascular insufficiency or vasculitis prompted an extensive imaging work-up. CT and MRI revealed the intramuscular abnormalities observed on previous ultrasound represented foci of intramuscular hemorrhage. Marrow signal abnormality was also noted in the proximal tibia. A punch biopsy of the skin rash ultimately demonstrated distorted hair follicles with perifollicular inflammation and hemorrhage concerning for scurvy. The diagnosis was confirmed by low vitamin C levels and dietary history. A resurgence of scurvy has occurred in the pediatric population in recent years. However, this diagnosis remains uncommon in adults, with limited reports of the potential advanced imaging findings in the current literature.
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Irvine I, Walshe T, Capra M, Hayes R. Scurvy: an unusual complication of paediatric cancer treatment. Skeletal Radiol 2019; 48:995-998. [PMID: 30374635 DOI: 10.1007/s00256-018-3103-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 02/02/2023]
Abstract
Scurvy is a disease that is rarely encountered in modern medicine. A condition that was classically associated with sailors, its incidence has decreased dramatically since the discovery of its association with vitamin C deficiency. We present the case of a 2-year-old boy, whose treatment for neuroblastoma was complicated by gastrointestinal disease, which necessitated enteral feeding. While still undergoing treatment, he started to complain about increasing pain in his lower limbs, which appeared to be markedly tender on palpation. Radiographic findings suggested a diagnosis of scurvy, which was subsequently confirmed on serum biochemistry. This was an unexpected finding, as the child had been receiving adequate vitamin C in his enteral feeds. However, his absorption had become severely impaired due to pseudomembranous gastritis and enteritis, leading to his deficient state. He significantly improved after intravenous ascorbic acid replacement and demonstrated a full recovery, both clinically and radiologically. This case highlights the importance of considering scurvy in the differential diagnosis for at-risk patients. Early recognition can facilitate the simple treatment of this potentially serious condition.
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Affiliation(s)
- Iain Irvine
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
| | - Triona Walshe
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Michael Capra
- Department of Oncology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Roisin Hayes
- Department of Radiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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50
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Swed-Tobia R, Haj A, Militianu D, Eshach O, Ravid S, Weiss R, Aviel YB. Highly Selective Eating in Autism Spectrum Disorder Leading to Scurvy: A Series of Three Patients. Pediatr Neurol 2019; 94:61-63. [PMID: 30795887 DOI: 10.1016/j.pediatrneurol.2018.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/15/2018] [Accepted: 12/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Some children with autism spectrum disorder (ASD) have highly specific food selectivity and therefore are prone to nutritional deficiencies of different kinds. PATIENTS We document three children with ASD who presented with refusal to walk and gingivitis who underwent comprehensive evaluations before establishing the diagnosis of vitamin C deficiency (scurvy). The symptoms resolved after treatment with vitamin C. CONCLUSIONS Prevention of nutritional deficiencies in children with ASD is essential, and providing multivitamin supplementation whenever high food selectivity is noted may prevent significant morbidity.
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Affiliation(s)
- Rana Swed-Tobia
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel.
| | - Ahmad Haj
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Daniella Militianu
- Department of Radiology, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Orly Eshach
- Pediatric Gastroenterology Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Sarit Ravid
- Pediatric Neurology Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Ram Weiss
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Yonatan Butbul Aviel
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel; Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
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