Scurvy masquerading as IgA vasculitis

Hanna L Kassa; S Singh; M Douglas-Jones; Gill Schermbrucker; J De Lange; Frank Phoya; Claire Butters; Carol Hlela; Ashton Coetzee; Ebrahim Banderker; Kate Webb

doi:10.1186/s12969-024-00992-2

Scurvy masquerading as IgA vasculitis

Pediatr Rheumatol Online J. 2024 May 18;22(1):56. doi: 10.1186/s12969-024-00992-2.

Authors

Hanna L Kassa¹, S Singh², M Douglas-Jones³, Gill Schermbrucker⁴, J De Lange³, Frank Phoya⁵, Claire Butters⁵, Carol Hlela⁵, Ashton Coetzee⁶, Ebrahim Banderker⁵, Kate Webb⁵

Affiliations

¹ Department of Pediatric Rheumatology, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa. Hanna.lishan@aau.edu.et.
² National Health Laboratory Service, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
³ Department of Maxillofacial and Oral Surgery, Groote Schuur and Red Cross Children's Hospital, University of the Western Cape, Cape Town, South Africa.
⁴ Victoria Hospital, Wynberg, Cape Town, South Africa.
⁵ Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
⁶ Department of Paediatric Nephrology, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa.

Abstract

Background: Vitamin C deficiency, or scurvy, is rare but poses risks for children with poor diets, limited resources, or malabsorption issues. It may also be common in children with restrictive or selective dietary habits in children with global developmental delay, autism spectrum disorder, and physical disabilities. Symptoms include fatigue, irritability, joint and muscle pain, joint swellings, edema, swollen gums, easy bruising, and delayed wound healing. Early recognition and prompt intervention are essential to prevent the progression of symptomatic vitamin C deficiency in children.

Case presentation: We present a case of a 13-year-old boy with developmental delay secondary to Lennox Gastaut syndrome referred for suspected recurrent, severe, and atypical IgA vasculitis. He presented with irritability, loss of appetite, petechial and ecchymotic lower limb lesions, unilateral gum swelling, severe arthritis, peripheral oedema, severe weight loss, anaemia, and raised inflammatory markers. Multiple investigations were performed before the diagnosis of scurvy was made. A surgical finding of friable gingival tissue with multiple loose teeth, a skin biopsy with follicular hyperkeratosis and extravasated perifollicular red blood cells, and a typical X-ray finding led to the diagnosis of scurvy.

Conclusion: Scurvy should be given careful consideration as a differential diagnosis in patients presenting with musculoskeletal issues, mucocutaneous complaints, and constitutional symptoms such as malaise, asthenia, irritability, and loss of appetite. A focused and detailed dietary history looking for a lack of good sources of vitamin C can be an easy indicator of this differential. Imaging studies revealing the typical features can also help make the diagnosis. Pathology of the skin revealing pathognomonic features can add to the certainty of the diagnosis. In the absence of all else, the rapid response to treatment with an appropriate dose of vitamin C has a diagnostic and therapeutic role.

Keywords: Henoch Schonlein Purpura; IgA vasculitis; Purpuric-rash; Scurvy; Selective-diet; Vitamin-C.

Publication types

Case Reports

MeSH terms

Adolescent
Ascorbic Acid* / therapeutic use
Diagnosis, Differential
Humans
IgA Vasculitis / diagnosis
Male
Scurvy* / diagnosis