Recently a rare case of scurvy in a 2-year-old girl diagnosed on an X-ray was reported in Buffalo, NY, U.S.A, and published in the Visual Journal of Imaging in Emergency Medicine.
Even now a days Scurvy is reported sporadically in the developed world.The subclinical vitamin C deficiency in the general population is being recognized increasingly. Therefore the need for clinicians to be aware of this disease remains. Vitamin C deficiency must persist for eight to 12 weeks before it causes scurvy.
In this case report, by a group of researchers from Buffalo, U.S.A. the girl presented with history of petechial rash. On arrival, she was described as underweight and disheveled, and she was not able to bear weight due to bilateral leg pain. She had been complaining of intermittent fever and joint pain for a month.
An initial oropharyngeal exam revealed mucous membranes with bleeding and receding gingiva, while a dermatologic exam revealed scant scattered ecchymosis and bilateral petechiae with perifollicular hemorrhages most prominent on her lower extremities, wrote the authors of the report.
There was no prior diagnosis of developmental delay was reported in the case. But due to concern for neglect, a skeletal survey was ordered.
The following findings were seen on the x-ray of the girl's distal femur and proximal tibia:
Frankel lines: Dense zones of provisional calcification
Pelkan spurs: Bony spurring at the periphery of the zone of metaphyseal calcification
Trümmerfeld zone: Lucent bands in the metaphysis below the Frankel line
X-ray of the patient's left knee showed dense zones of provisional calcification (F: Fraenkel line) with underlying lucent metaphyseal bands (T: Trummerfeld zone). In addition spurring at the distal femur and proximal tibia (P: Pelkan spurs) and a displaced fracture of distal femoral metaphysis was also identified.
Although the clinical and radiographic characteristics of scurvy were well defined but the the diagnosis was clinched by most reliable test- the girl's vitamin C level.
The authors reported that the patient rapidly improved after receiving vitamin C supplements, which retrospectively confirmed the diagnosis.
Case study Reference:
A 2-year-old with Scurvy: A Modern case of a historical disease by Wiese M et. al published in the Visual Journal of Emergency Medicine.
https://doi.org/10.1016/j.visj.2021.101122