Scurvy in autism spectrum disorder-associated food selectivity: a case report

Introduction: Alert healthcare professionals about the possibility of scurvy in autistic patients with extreme food selectivity. Case Description: A 3-year-old male child was admitted to hospital due to two-month-long claudication, constipation and lower-limb pain complains, and a history of oral injury. After medical evaluation, no significant changes were found in complementary exams and imaging. The hospital dentistry team examined him and found a granulomatous lesion in both upper alveolar ridge and gingiva as well as other small granulomas scattered bilaterally in the posterior maxillary gingiva. An incisional biopsy showed the morphological appearance of a non-specific inflammatory process with the formation of exuberant granulation tissue. Hypovitaminosis C was hypothesized because of the gingival condition, petechiae in the lower limbs, and dietary restrictions. This hypothesis was confirmed through laboratory tests. Vitamin C was administered orally at a dose of 300mg once a day. Upon gradual improvement of his limb movements and oral lesions. Discussion: Scurvy is caused by a severe deficiency of vitamin C, or ascorbic acid, in the body. This vitamin plays an important role in regulating intracellular redox potential. It is essential for collagen synthesis, which facilitates the enzymatic hydroxylation of proline into hydroxyproline. Failure in collagen synthesis impairs wound healing and causes poor fibroblast and osteoblast functions. Vitamin C deficiency increases susceptibility to periodontal diseases. Conclusion: The food selectivity commonly present in autism spectrum disorder is characterized by monotonous diets that often lack foods containing vitamin C, increasing the risk of scurvy and its consequences.