Scurvy in pediatrics, revisiting a historical disease: A report of two children

Scurvy is a forgotten disease of childhood that occurs secondary to prolonged severe dietary deficiency of vitamin C. It can manifest as a multisystemic disease resulting from prolonged severe deficiency of vitamin C. Musculoskeletal symptoms can be the presenting signs in children with physical or mental disabilities. We are presenting two children with scurvy. Patient A is a 4-year-old irritable boy maintained on boiled food since birth and presenting with wrist and hip pain. Radiographs revealed a subperiosteal hematoma, Wimberger ring sign, and white line of Fraenkel. Patient B is a 30-month-old girl with bowed legs, maintained on milk only since birth, and presented with bilateral leg/knee arthralgias and decreasing ambulation; she also had pithed frog leg posture. Pelvic radiographs revealed osteopenia, narrow physis, pencil-thin cortex, and Pelkan spurs. Vitamin C levels were low (<0.2 mg/dL), and symptoms resolved with vitamin C supplementation. Despite the rarity of vitamin C deficiency among pediatric patients, clinicians need to consider scurvy in the context of proper clinical findings to avoid misdiagnosis and delayed treatment.