Unusual Gingival Findings Leading to the Diagnosis of Scurvy in a Child with Autism Spectrum Disorder: A Case Report

Abstract Scurvy is an uncommon condition in modern clinical practice but may still occur in children with restrictive dietary habits, particularly those with neurodevelopmental disorders. This report describes the case of a 9 year old boy with non-verbal autism spectrum disorder (ASD), who initially presented with poor oral hygiene and generalised gingivitis and underwent comprehensive dental treatment under general anaesthesia. Two weeks later, he developed progressive gingival swelling, spontaneous bleeding, halitosis, reduced oral intake, facial puffiness, weight loss, and systemic weakness, with clinical deterioration observed despite antibiotic therapy and antiseptic mouthwashes. Intraoral examination revealed generalised spongy, hypertrophic, and erythematous gingiva with purplish red gingival appearance and sloughing. Dietary assessment demonstrated a severely restricted intake consisting predominantly of roti canai and milk based beverages, with complete avoidance of fruits and vegetables. Laboratory investigations showed anaemia, thrombocytosis, abnormal red blood cell morphology, prolonged prothrombin time, and markedly reduced plasma vitamin C levels (<0.1 mg/dL). A diagnosis of scurvy secondary to dietary vitamin C deficiency was established following multidisciplinary evaluation. The patient was treated with oral vitamin C supplementation, multivitamins, folate, dietary modification, and supportive oral hygiene care, resulting in rapid clinical improvement within 1 week and complete resolution of gingival manifestations by 2 weeks. This case highlights the importance of considering nutritional deficiencies in ASD children presenting with atypical or treatment resistant gingival disease and emphasises the critical role of dietary history and multidisciplinary management in achieving timely diagnosis and effective treatment.