Clinical Pediatrics http://cpj.sagepub.com/
Scurvy Mimicking Osteomyelitis: Case Report and Review of the Literature Kathleen M. W. Harknett, Sumreen K. Hussain, Mary K. Rogers and Niraj C. Patel CLIN PEDIATR 2014 53: 995 originally published online 17 October 2013 DOI: 10.1177/0009922813506609 The online version of this article can be found at: http://cpj.sagepub.com/content/53/10/995
Published by: http://www.sagepublications.com
Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Jul 31, 2014 OnlineFirst Version of Record - Oct 17, 2013 What is This?
Downloaded from cpj.sagepub.com at Mount Royal University on August 18, 2014
506609
research-article2013
CPJXXX10.1177/0009922813506609Clinical PediatricsHarknett et al
Brief Report
Scurvy Mimicking Osteomyelitis: Case Report and Review of the Literature
Clinical Pediatrics 2014, Vol. 53(10) 995–999 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922813506609 cpj.sagepub.com
Kathleen M. W. Harknett, MD1, Sumreen K. Hussain, MD1, Mary K. Rogers, MD1, and Niraj C. Patel, MD, MS1 Introduction Scurvy, or vitamin C deficiency, is a rare condition in pediatric patients. Childhood scurvy was associated with the pasteurization of milk for infants, which destroys vitamin C.1 Sporadic cases of scurvy continue to appear in both children and adults. We report a case of a child with laboratory and radiographic findings of scurvy, and review the pediatric literature.
Case Report A 9-year-old African American male with a history of autism and nonverbal communication presented to a children’s hospital with refusal to bear weight and a draining mouth sore. The patient had jumped off of a bed and hit his left knee 6 weeks earlier. He initially favored his left knee; however, a plain radiograph at an urgent care facility was negative. The following week, he developed pain in his right leg and a mouth sore. A dental exam during this time revealed gingival bleeding that was attributed to poor dental hygiene. The gingival bleeding progressed and leg swelling developed 2 weeks prior to admission and was accompanied by refusal to bear weight. Plain radiographs of his left leg were unremarkable 1 week prior to admission. Swelling and warmth of the left knee and drainage of yellow-green fluid from a mouth sore prompted evaluation in the emergency department. At presentation, he was afebrile, had a pulse of 124, blood pressure 114/62 mm Hg, and respiratory rate of 22. His weight was at the 37th percentile, height at the 56th percentile, and body mass index at the 20th percentile. Physical examination was remarkable for severe gingivitis with purulent fluid at the gingival line as well as warmth, erythema, tenderness, and swelling of the proximal anterior left tibia with limited range of motion of the left knee and no appreciable effusion. Laboratory evaluation revealed a normal white blood cell count, normocytic anemia, erythrocyte sedimentation rate >140 mm/h, and C-reactive protein 1.3 mg/dL (normal
Scurvy Mimicking Osteomyelitis: Case Report and Review of the Literature Kathleen M. W. Harknett, Sumreen K. Hussain, Mary K. Rogers and Niraj C. Patel CLIN PEDIATR 2014 53: 995 originally published online 17 October 2013 DOI: 10.1177/0009922813506609 The online version of this article can be found at: http://cpj.sagepub.com/content/53/10/995
Published by: http://www.sagepublications.com
Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Jul 31, 2014 OnlineFirst Version of Record - Oct 17, 2013 What is This?
Downloaded from cpj.sagepub.com at Mount Royal University on August 18, 2014
506609
research-article2013
CPJXXX10.1177/0009922813506609Clinical PediatricsHarknett et al
Brief Report
Scurvy Mimicking Osteomyelitis: Case Report and Review of the Literature
Clinical Pediatrics 2014, Vol. 53(10) 995–999 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922813506609 cpj.sagepub.com
Kathleen M. W. Harknett, MD1, Sumreen K. Hussain, MD1, Mary K. Rogers, MD1, and Niraj C. Patel, MD, MS1 Introduction Scurvy, or vitamin C deficiency, is a rare condition in pediatric patients. Childhood scurvy was associated with the pasteurization of milk for infants, which destroys vitamin C.1 Sporadic cases of scurvy continue to appear in both children and adults. We report a case of a child with laboratory and radiographic findings of scurvy, and review the pediatric literature.
Case Report A 9-year-old African American male with a history of autism and nonverbal communication presented to a children’s hospital with refusal to bear weight and a draining mouth sore. The patient had jumped off of a bed and hit his left knee 6 weeks earlier. He initially favored his left knee; however, a plain radiograph at an urgent care facility was negative. The following week, he developed pain in his right leg and a mouth sore. A dental exam during this time revealed gingival bleeding that was attributed to poor dental hygiene. The gingival bleeding progressed and leg swelling developed 2 weeks prior to admission and was accompanied by refusal to bear weight. Plain radiographs of his left leg were unremarkable 1 week prior to admission. Swelling and warmth of the left knee and drainage of yellow-green fluid from a mouth sore prompted evaluation in the emergency department. At presentation, he was afebrile, had a pulse of 124, blood pressure 114/62 mm Hg, and respiratory rate of 22. His weight was at the 37th percentile, height at the 56th percentile, and body mass index at the 20th percentile. Physical examination was remarkable for severe gingivitis with purulent fluid at the gingival line as well as warmth, erythema, tenderness, and swelling of the proximal anterior left tibia with limited range of motion of the left knee and no appreciable effusion. Laboratory evaluation revealed a normal white blood cell count, normocytic anemia, erythrocyte sedimentation rate >140 mm/h, and C-reactive protein 1.3 mg/dL (normal
