Scurvy in the Modern Era: Revisiting a Forgotten Diagnosis in a Child With Chronic Recurrent Multifocal Osteomyelitis

Scurvy, an ancient disease caused by severe vitamin C deficiency, continues to resurface in modern settings, especially among patients with selective eating habits due to developmental disorders, feeding difficulties, or low socioeconomic status. This report describes the case of a three-year-old child who presented with five weeks' history of multisystemic symptoms, such as systemic (fever, generalized edema), musculoskeletal (bone pain), dermatological (petechiae), and mucosal (gingivitis), leading to a diagnostic dilemma. The patient underwent extensive workups, including biopsies and infectious and autoimmune tests, all of which were negative. Clinical and radiological findings initially suggested chronic recurrent multifocal osteomyelitis (CRMO), which is a rare diagnosis of exclusion, frequently considered in children with unexplained multifocal bone lesions, and can easily lead to misdiagnosis. The turning point came from the child's dietary history, primarily consisting of rice, raising suspicion for nutritional deficiency. Micronutrient testing revealed a severely low vitamin C level, confirming the diagnosis of scurvy. Oral supplementation resulted in the complete resolution of his gingivitis, petechiae, and edema within one week. Scurvy is often overlooked in modern practice despite its simple diagnosis and treatment with ascorbic acid. This case highlights the diagnostic challenge posed by the overlap of symptoms (bone pain) and radiological findings between scurvy and CRMO. It also emphasizes the importance of detailed dietary history and recognition of nutritional deficiencies in the differential diagnosis in children with multisystem involvement.